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Query: UMLS:C0162871 (abdominal aortic aneurysm)
 8,664 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report a case of abdominal aortic aneurysm with giant bulla in a 58-year-old man who had an elective abdominal aortic reconstruction surgery. Preoperative chest x-ray showed a giant bulla in the right lung and small bullae in the left. General anesthesia was induced with midazolam 0.5 mg, fentanyl 0.2 mg and succinylcholine chloride 80 mg. After tracheal intubation, anesthesia was maintained under spontaneous breathing with halothane 0.5-1% in a mixture of air and oxygen (FIO2 0.4-1.0) supplemented with continuous epidural mepivacaine from the catheter inserted the day before surgery. Since satisfactory analgesia and muscle relaxation were achieved by epidural mepivacaine, no analgesics and muscle relaxants were administered during the operation. Postoperatively, no complications occurred and the patient was extubated and transferred to the intensive care unit. We emphasize that combined epidural and light general anesthesia with spontaneous respiration might be ideal for the safe anesthetic management of a patient with a giant bulla.
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PMID:[Anesthetic management of a patient with abdominal aortic aneurysm (AAA) with giant bulla]. 830 43

Twenty patients undergoing elective abdominal aortic aneurysm repair were randomly allocated to two groups and studied for 24 h following surgery. Postoperative analgesia was provided by epidural bupivacaine infusion and intravenous patient-controlled 0.05 mg boluses of alfentanil. One treatment group received 7 ml.h-1 of a 0.25% solution of bupivacaine, the other 25 ml.h-1 of a 0.07% solution. The rate of infusion was thus 17.5 mg.h-1 in both groups. Patients receiving 7 ml.h-1 of epidural infusate required more doses of alfentanil (median 26.5, range 0-50) than the group receiving 25 ml.h-1 of the dilute infusion (median 3.0, range 0-16). It is concluded that 17.5 mg.h-1 of bupivacaine infused into the epidural space produces better analgesia when infused in a volume of 25 ml.h-1 (0.07%) than when given in a volume of 7 ml.h-1 of solution (0.25%).
Anaesthesia 1994 Jan
PMID:Epidural bupivacaine for aortic surgery. The effect of dilution on the quality of analgesia. 831 Dec 5

Twenty-four patients undergoing abdominal aortic aneurysm (AAA) repair were studied to compare the effects of lumbar epidural anesthesia (LEA) and general anesthesia (GA) on plasma catecholamine levels and hemodynamics before and during infrarenal aortic cross-clamping. Patients received either a high dose of opioid anesthetic (GA group, n = 12), or lumbar epidural anesthesia to T4 sensory level with a light general anesthetic (LEA group, n = 12). Systemic vascular resistance (SVR) and norepinephrine (NE) and epinephrine (E) levels were measured before anesthetic induction (before epidural activation in the LEA group, and before general anesthesia induction in the GA group), 15 min before cross-clamping, and 1,5, and 10 min after cross-clamping. There was a large (P < 0.05) increase in NE and E in the GA group by 15 min before aortic cross-clamping, but NE and E levels in the LEA group did not increase. The GA group had significantly higher levels of NE and E than the LEA group 15 min before cross-clamping and also after clamping. NE levels in the LEA group increased after cross-clamping, and NE levels in the GA group remained constant. E levels remained stable in both groups after cross-clamping. After clamping, SVR increased in both groups, but the increase occurred after 1 min in the GA group and took 5 min to become significant in the LEA group. There was no significant correlation between changes in NE or E and changes in SVR in either group. This study shows that epidural anesthesia to T4 prevents NE and E increases in response to abdominal surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The effect of lumbar epidural and general anesthesia on plasma catecholamines and hemodynamics during abdominal aortic aneurysm repair. 831 Dec 73

From 1.1.1988 tot 31.8.1991, 42 surgical revascularisations of the aorta and the lower limbs were performed on patients aged 75 and more (men: 24--women: 18; extreme ages: 75-84; average age: 80). In all cases surgery was absolutely indicated: for advanced arteriopathy in the lower limbs (stage III or IV of Fontaine's classification) (37 cases) and ruptured abdominal aortic aneurysm (5 cases). No primary major amputation was performed in the peripheral vascular group stages III and IV. Peripheral vascular occlusive disease (30 cases) was operated under locoregional anaesthesia and consisted of the femoro-distal popliteal bypass with in situ saphenous vein (23 cases). Patients with proximal lesions preferably underwent an extra-anatomic bypass under general anaesthesia (7 cases). Ruptured infrarenal aortic aneurysm also needs a general anesthesia and represents a high surgical risk (5 cases). For the 42 patients, we observed 38 good immediate functional results and 4 peri-operative deaths. Of the 38 immediate good results, we observed 6 secondary obliterations of the bypass within a period of 5 to 18 months, among which 2 were successfully disobliterated. The other 4 patients underwent lower limb amputation.
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PMID:Surgical pathology of aorta and arteries of the lower limbs in the elderly. 837 87

Infrarenal aortic cross-clamping required during surgical treatment of abdominal aortic aneurysm is generally well tolerated but can be occasionally associated with severe cardiac and haemodynamic disturbances, particularly in patients suffering from coronary artery disease. We compared the haemodynamic changes and the ECG-records before and shortly after infrarenal aortic clamping in three groups of 20 patients (group I: without coronary artery disease, group II: with overt coronary disease without indication for prior myocardial revascularization, and group III: patients undergoing combined procedure: coronary artery bypass immediately prior to aortic repair, during the same anesthesia). There was no significant difference in demographical characteristics between the three groups. Aortic cross-clamping lead to an increase in systemic arterial pressure in all patients. Group I demonstrated a decrease in pulmonary artery pressure, pulmonary capillary wedge pressure and central venous pressure, whereas patients of group II demonstrated an increase of each value when the aorta was clamped. 11 patients of this group developed either arrhythmia and/or ischemia during aortic cross-clamping. Haemodynamic and cardiac effects of aortic clamping seen in patients who had received coronary bypass immediately prior to aortic repair (group III) were surprisingly similar to those of patients without coronary disease, probably owing to systematic application of 2 vasodilators. Tolerance to infrarenal aortic cross-clamping differs in patients with and without coronary artery disease. Development of myocardial ischemia may be predicted by an increase in wedge pressure after clamping. Afterload reduction was the best treatment of ischemia occurring when the aorta was clamped.
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PMID:[Effect of aortic clamping on heart function in elective operation of the abdominal aorta: immediate effects of coronary revascularization]. 837 52

The effect of anesthetic induction and surgical incision on activated clotting time (ACT) was determined in patients undergoing vascular surgery. Patients undergoing carotid endarterectomy (CAE) (n = 50) and abdominal aortic aneurysm repair (AAA) (n = 45) were studied. Patients in the CAE group had cervical plexus block anesthesia, whereas patients in the AAA group had a combination of epidural and general anesthesia. The ACT was measured 1) before induction of anesthesia, 2) 5 min after induction, 3) 5 min after incision, 4) 5 min after heparinization, and 5) at the onset of skin closure. Heparin was reversed with protamine only if the ACT after revascularization was > 200 s. Reversal was considered adequate if the ACT was < 200 s and the surgeon felt that hemostasis was adequate. The ACT decreased by 12.26 +/- 1.23 (mean +/- SE) (P = 0.006) in the CAE group and by 12.47 +/- 1.01 (P = 0.002) in the AAA group with induction of anesthesia. There was a further decrease of 5.06 +/- 0.62 (P = 0.26) in the CAE group and 5.17 +/- 0.83 (P = 0.22) in the AAA group with incision. There was a significant difference in ACT in both groups from postinduction and postincision to skin closure (higher at skin closure). No patient in either group required additional protamine or clotting factors post-operatively, or return to the operating room for excessive bleeding. This study demonstrates that anesthetic induction with cervical block or epidural/general anesthesia decreases ACT.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The effect of epidural/general and cervical plexus block anesthesia on activated clotting time in patients undergoing vascular surgery. 846 4

Atrial natriuretic factor (ANF) is a peptide hormone released from atrial cardiocytes in response to atrial stretch. It has potent and selective effects on vascular smooth muscle, fluid and electrolyte balance, and may interact with other vasoactive substances. The influence of anaesthesia and major vascular surgery on the release and circulation of ANF is unknown. Therefore the relationships between haemodynamic variables, volume expansion and plasma ANF were studied in patients undergoing resection of abdominal aortic aneurysm, randomly assigned to receive isoflurane or propofol+fentanyl anaesthesia. The end point of anaesthetic regimens was the stabilization of mean arterial pressure between +/- 33% from baseline. Haemodynamic parameters and plasma ANF levels were measured preoperatively, after intubation, following aortic cross-clamping, 24 and 48 hours postoperatively. Because of well-known large degree in interpatient pharmacodynamic variability, anaesthesia with propofol and fentanyl did not ensure, usually, the established end point in dose ranges that did not produce unacceptable morbidity. ANF plasma levels were elevated during surgery and in the immediate postoperative period in both groups. A significant correlation was found between ANF levels and mean right atrial pressure. We concluded that anaesthetic drugs do not affect ANF release. Volume expansion for prevention of declamping shock increased, ANF from basal values, during surgery. Inadequacy of postoperative analgesia or persisting atrial stretch could explain the finding of high plasma levels during the immediate postoperative period.
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PMID:[Plasma levels of atriopeptin and hemodynamics during major vascular surgery: comparison between isoflurane and propofol+fentanyl]. 851 49

Ischaemia-reperfusion injury generates oxygen-derived free radicals leading to local and distant damage. A simple method of following oxidative activity is to measure the consumption of endogenous scavenging antioxidants; an enhanced chemiluminescent assay was used to study this phenomenon in 21 patients undergoing surgery for abdominal aortic aneurysm (AAA). Samples of peripheral venous blood were taken before induction of anaesthesia and then from a central venous line and the inferior mesenteric vein before, during, and after clamping of the aorta. Further specimens were taken from the central line at 2, 6 and 24 h after operation. Antioxidant concentration in the peripheral, central and inferior mesenteric blood were similar, indicating that anaesthesia and surgical dissection had no effect. Levels decreased significantly in central and inferior mesenteric blood during and after clamping, but returned to normal by 24 h. These results confirm ischaemia-reperfusion phenomena in AAA repair.
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PMID:Antioxidant depletion during aortic aneurysm repair. 866 7

A survey was conducted among 259 New Zealand specialist anaesthetists to assess attitudes and practices with regard to epidural or subarachnoid anaesthesia (ESA). Ninety-four per cent replied and virtually all of the respondents indicated that they performed ESA at some time. ESA was used by most anaesthetists for most patients undergoing major hip or knee surgery, abdomino-perineal resection, cystectomy, caesarean section or transurethral resection of the prostate, ESA was used is about half of patients undergoing abdominal aortic aneurysm repair, femoro-popliteal bypass or thoracotomy and there was marked variation between anaesthetists in the frequency of using ESA for these procedures. There was broad consensus about the importance of a number of factors that might influence the decision to employ ESA; in particular that systemic sepsis and prolonged bleeding time were important contraindications and that patient preference and chronic lung disease were important indications. However respondents were equally divided as to whether they felt that recent myocardial infarction or congestive heart failure constituted indications or contraindications to ESA.
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PMID:Attitudes and practices of New Zealand anaesthetists with regard to epidural and subarachnoid anaesthesia. 866 60

Intraoperative transesophageal echocardiography (TEE) was performed on a 62-year-old man who underwent abdominal aortic replacement for abdominal aortic aneurysm under general anesthesia combined with epidural anesthesia. Coronary artery spasm occurred after unexpected massive hemorrhage, and TEE showed hypokinesis in the posterior-inferior left ventricular wall. The changes in TEE preceded the ST elevation in the ECG. Bolus infusion of isosorbide dinitrate and continuous infusion of nitroglycerin alleviated these changes. TEE enabled us to detect and evaluate coronary spasm before the appearance of ST changes in ECG.
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PMID:[Usefullness of transesophageal echocardiography in early detection of coronary spasm]. 872 8


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