Vascular Anesthesia Procedures by Richard Urman;Alan Kaye;

Author:Richard Urman;Alan Kaye;
Language: eng
Format: epub
Publisher: OUP Premium
Published: 2021-10-15T00:00:00+00:00

b. Surgical factors

i. Understand the surgical plan with extent of coverage and perfusion to the branch vessels

ii. Consider risk-reducing strategies such as neuromonitoring, lumbar drain for spinal cord protection, blood pressure goals to mitigate organ perfusion and risks for aortic rupture, and more

2. Intraoperative care

a. General anesthesia with oral endotracheal tube is preferred.

b. Monitoring

i. ASA stand monitor, continuous right radial arterial pressure, central venous pressure (CVP), urine output

ii. Neuromonitoring: SSEP, motor evoked potential, NIRS monitors placed over the cervical spine and lower thoracic spine to detect SCI

iii. Lumbar cerebrospinal fluid (CSF) drain: Indications for a lumbar drain are anticipated endograft coverage of T9–T12, thoracic aortic coverage of greater than 20 cm, compromised collateral pathways, or symptomatic SCI in a patient who did not have a drain placed preoperatively.

iv. Transesophageal echocardiography (TEE): An important adjunct to fluoroscopy. It evaluates aortic pathology and cardiac function, identifies true and false lumen in the case of aortic dissections, guides the guidewire placement, confirms proper deployment of the endograft, and evaluates endoleaks. It potentially decreases contrast usage.

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