Abdominal Aortic Aneurysm (AAA) Open Repair 

 

 

 

Considerations 

 

  • Potential for hemorrhage, large fluid shifts & hypothermia 

  • Cross-clamp level & cross-clamp/unclamp physiology

  • Associated comorbid disease (coronary disease, hypertension, diabetes, renal failure, COPD, smoking)

  • Perioperative organ dysfunction (cardiac, renal, visceral, spinal cord ischemia) & complication (MI/renal failure/heart failure/paralysis/death)

  • Postoperative pain control & monitoring in high acuity unit/ICU

  • For ruptured AAA, add the following: 

    • Full stomach, limited time to optimize

    • Emergency procedure requiring immediate OR

    • Need for extra help, second anesthesiologist 

    • Hemorrhagic shock with high mortality (85%)

 

 

Goals 

 

  • Adequate resuscitation of massive hemorrhage to goal end points 

  • Management of comorbidities 

  • Minimize hemodynamic changes associated with aortic cross clamping & unclamping

 

 

Conflicts

 

 

  • Hemodynamic instability vs. full stomach and need for RSI

  • Requirement for immediate OR vs. resuscitation

 

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