Anesthetic Management of Surgical Repair of Descending Thoracic Aortic Aneurysm

Abstract

Anesthetic management of surgical repair of descending thoracic aortic aneurysm is a difficult mission for anesthesiologists. The surgical approach is best achieved through left postero-lateral thoracotomy with the use of one lung ventilation. The post-operative outcome is affected by the presence of associated co morbidities such as cardiac and renal diseases, the severe intra-operative hemodynamic fluctuations and the use of mechanical circulatory assisted devices. The severe hemodynamic fluctuations that result from clamping and declamping the descending thoracic aorta require an experienced cardiac anesthesiologist for the proper perioperative management of these patients. The aim of this review is to give new insights on the anesthetic management and the techniques of distal perfusion using partial cardiopulmonary bypass. Anesthetic goals are directed to provide spinal cord and renal protection with controlling the proximal hypertension.