Clinical Procedure
 
Aliases:
Open repair of ruptured abdominal aortic aneurysm

Topic aliases are alternate phrasings for a particular topic.


If the aneurism is ruptured, consider allowing permissive hypotension (eg titrate IV volume boluses to the patient's concious state) to minimise bleeding until the aorta is clamped

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If the aneurism is ruptured, transfer to the operating theater urgently for surgical hemostasis. Prior to transfer, ensure the patient's airway and breathing are stabilised, and large bore intravenous access is obtained to facilitate intravascular volume resuscitation as required.

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If ruptured, enlist help from second anesthesiologist for help with intraoperative line insertion & blood product logistics

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Large bore IV access eg ric line or at least 14g cannulla.

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If free intraperitoneal rupture, goal is rapid aortic cross clamping. Insert 1 large IVC prior to induction. Don't delay by placing ART line or central line

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Intra-arterial blood pressure monitoring will be required, but arterial catheter insertion should not delay clamping of the aorta in patients with an uncontained rupture.

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High risk for intraoperative awareness if ruptured. Consider benzodiazepines and BIS/Entropy monitoring.

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If ruptured, surgeon to be scrubbed & patient prepped prior to induction to minimise time between induction & cross clamping

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Slow wake and wean in intensive care unit postoperatively to manage respiratory and cardiovascular consequences of large intraoperative fluid shifts and likely massive transfusion.

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