Abdominal Aortic Aneurysm (AAA) Open Repair
Considerations
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Potential for hemorrhage, large fluid shifts & hypothermia
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Cross-clamp level & cross-clamp/unclamp physiology
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Associated comorbid disease (coronary disease, hypertension, diabetes, renal failure, COPD, smoking)
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Perioperative organ dysfunction (cardiac, renal, visceral, spinal cord ischemia) & complication (MI/renal failure/heart failure/paralysis/death)
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Postoperative pain control & monitoring in high acuity unit/ICU
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For ruptured AAA, add the following:
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Full stomach, limited time to optimize
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Emergency procedure requiring immediate OR
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Need for extra help, second anesthesiologist
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Hemorrhagic shock with high mortality (85%)
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Goals
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Adequate resuscitation of massive hemorrhage to goal end points
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Management of comorbidities
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Minimize hemodynamic changes associated with aortic cross clamping & unclamping
Conflicts
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Hemodynamic instability vs. full stomach and need for RSI
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Requirement for immediate OR vs. resuscitation