Endoluminal abdominal aortic aneurism AAA repair : Colligative - Practical Wisdom in Anesthesia, Surgery, and Medicine.

Mar 18, 2014

If vessel rupture occurs, ask the surgeon whether they can occlude proximally with a balloon as a temporising measure until they can place a stent or convert to open.

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

May 24, 2012

Preoperative Optimisation

Cancel

0

Assessment, Workup

Cancel

0

Consent, Discussion

Cancel

0

Cancel

0

Coordinating

Cancel

0

Medication management, Premed

Cancel

1

Equipment, Preparation

Considerations as for anaesthesia in-a-remote-hazardous-environment

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Sep 20, 2012

Cancel

1

Duration

Usually <2hrs duration. Higher aneurisms may take longer due to positioning of fenestrations for coeliac, renal, and mesenteric arteries

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Mar 22, 2012

Cancel

0

Anatomy

Cancel

0

IV access

Cancel

1

Monitoring

Place a 5 electrode ECG as the patient is usually at elevated risk of ischaemic heart disease

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Mar 18, 2014

Cancel

3

Special drugs

N acetyl-cysteine may reduce extent of contrast induced nephropathy. Cheap and low risk, so even if marginal benefit, consider adminstering. 2008 Review Ann Int Med. refl.in/hj

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Mar 18, 2014

Proceduralist may ask for hyoscine to reduce intestinal motility to improve image intensifier images

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

(1 comment)

Mar 18, 2014

20mg IV #ref

Edit | (delete)

Surgeon will probably ask for a heparin bolus and/or infusion

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Mar 18, 2014

Cancel

2

Airway, Ventilation

Consider general anesthesia if intraoperative access to the patient's airway will be difficult. If you need to convert to GA, you don't want to struggle with access to the patient.

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

May 18, 2011

Manual ventilation or PSV at end of case may avoid patient breathing/coughing against ventilator which could cause a haematoma at the puncture site.

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Mar 18, 2014

Positioning, Surgical access

Cancel

0

Cancel

0

Procedure technique

Cancel

5

Anesthesia, Analgesia, Antiemesis

Ask surgeon where they will be cutting to get arterial access. If accessing iliacs, incision will be high & through muscle, & will be difficult to cover with local, so will need regional or general

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

May 18, 2011

Breath holds will be required. If regional or local anesthesia being used, patient will need to be cooperative and responsive ("concious sedation").

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

May 18, 2011

General anaesthesia for those patients that won't be able to lie still for prolonged periods, or cooperate with breath holds.

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

May 18, 2011

If the procedure is to be performed awake, consider regional/neuraxial anesthesia to cover high incisions as these will require too much dissection to be adequately covered with local anaesthetic infiltration.
Patient will have to be able to lie still & cooperate with breathe holds throughout case.

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Mar 22, 2012

No difference in outcomes between GA vs LA/sedation for infrarenal EAAA. Study - 229 pts, 2002 refl.in/49

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

May 18, 2011

Cardiovascular, Renal, Fluids

Cancel

3

GTN infusion plus boluses may be helpful in managing hypertension on ballooning.

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Mar 18, 2014

More proximal ballooning will result in higher increase in SVR & BP as more of circulation (celiac, renal arteries) are excluded.

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

May 18, 2011

Reduce the risk of contrast induced nephropathy by ensuring patient is well hydrated.

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.

Cancel

Endorsed by , more...

Private

only

Sep 20, 2012