3 research outputs found
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ANESTHESIA FOR ABDOMINAL AORTIC RECONSTRUCTION
Anesthesia for abdominal aortic reconstruction can present some of the most difficult patient management problems likely to be encountered by the anesthesiologist. Although the stresses imposed upon the patient by aortic cross-clamping and unclamping are often well tolerated, the hemodynamic perturbations that result at times can be severe.
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Management of these hemodynamic derangements is further complicated by the fact that a high percentage of patients presenting for abdominal aortic reconstruction also present with a host of coexisting illnesses. Pulmonary disease, diabetes mellitus, renal insufficiency, and cerebrovascular disease may all, at one time or another, contribute to the difficulty in anesthetic management of patients undergoing abdominal aortic reconstruction and lead to perioperative complications; however, the greatest contributor to perioperative morbidity and mortality is concomitant cardiovascular disease.
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Vascular disease encompasses a wide variety of pathologies, including cerebrovascular disease, thoracic aortic disease, abdominal aortic disease, and cardiovascular and peripheral vascular diseases. The focus of this article, however, is on the anesthetic management of patients undergoing abdominal aortic reconstruction, with particular attention to those patients with concomitant coronary artery disease (CAD) and valvular heart disease
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Intraoperative transesophageal echocardiographic diagnosis of prosthetic conduit compression after valved conduit replacement of the ascending aorta
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Severity of Aortic Atheromatous Disease Diagnosed by Transesophageal Echocardiography Predicts Stroke and Other Outcomes Associated with Coronary Artery Surgery: A Prospective Study
Advanced atheromatous disease of the thoracic aorta identified by transesophageal echocardiography (TEE) is a major risk factor for perioperative stroke.This study investigated whether varying degrees of atherosclerosis of the descending aorta, as assessed by TEE, are an independent predictor of cardiac and neurologic outcome in patients undergoing coronary artery bypass grafting (CABG). Intraoperative TEE of the descending aorta was performed on 189 of 248 patients participating in a randomized controlled trial of low (50-60 mm Hg) or high (80-100 mm Hg) mean arterial pressure during cardiopulmonary bypass for elective CABG. Aortic atheromatous disease was graded from I to V in order of increasing severity by observers blinded to outcome. Measured outcomes were death, stroke, and major cardiac events assessed at 1 wk and 6 mo. Nine of the 189 patients with TEE examinations had perioperative strokes by 1 wk. At 1 wk, no strokes had occurred in the 123 patients with atheroma Grades I or II, while the 1-wk stroke rate was 5.5% (2/36), 10.5% (2/19), and 45.5% (5/11) for Grades III, IV, and V, respectively (Fisherʼs exact test, P = 0.00001). For 6-mo outcome, advancing aortic atheroma grade was a univariate predictor of stroke (P = 0.00001) and death (P = 0.03). By 6 mo there were one additional stroke, three additional deaths, and one additional major cardiac event. Atheromatous disease of the descending aorta was a strong predictor of stroke and death after CABG. TEE determination of atheroma grade is a critical element in the management of patients undergoing CABG surgery.(Anesth Analg 1996;83:701-8