Intraoperative care for aortic surgery using circulatory arrest
| Autor: | Blanca Pérez-Lozano, David Fernández del Valle, Adrián González Alvarez, Félix Ezequiel Fernández Suárez |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Pulmonary and Respiratory Medicine
Aortic arch business.industry Extracorporeal circulation Ischemia Review Article 030204 cardiovascular system & hematology Hypothermia medicine.disease 03 medical and health sciences Thromboelastometry 0302 clinical medicine 030228 respiratory system Bispectral index Anesthesia medicine.artery Ascending aorta medicine medicine.symptom Cerebral perfusion pressure business |
| Zdroj: | Journal of Thoracic Disease. 9:S508-S520 |
| ISSN: | 2077-6624 2072-1439 |
| Popis: | The total circulatory arrest (CA) is necessary to achieve optimal surgical conditions in certain aortic pathologies, especially in those affecting the ascending aorta and aortic arch. During this procedure it is necessary to protect all the organs of ischemia, especially those of the central nervous system and for this purpose several strategies have been developed. The first and most important protective method is systemic hypothermia. The degree of hypothermia and the route of application have been evolving and currently tend to use moderate hypothermia (MH) (20.1–28 °C) associated with unilateral or bilateral selective cerebral perfusion methods. In this way the neurological results are better, the interval of security is greater and the times of extracorporeal circulation are smaller. Even so, it is necessary to take into account that there is the possibility of ischemia in the lower part of the body, especially of the abdominal viscera and the spinal cord, therefore the time of circulatory stop should be limited and not to exceed 80 minutes. Evidence of possible neurological drug protection is very weak and only mannitol, magnesium, and statins can produce some benefit. Inhalational anesthetics and some intravenous seem to have advantages, but more studies would be needed to test their long-term benefit. Other important parameters to be monitored during these procedures are blood glucose, anemia and coagulation disorders and acid-base balance. The recommended monitoring is common in complex cardiovascular procedures and it is of special importance the neurological monitoring that can be performed with several techniques, although currently the most used are Bispectral Index (BIS) and Near-Infrared Spectroscopy (NIRS). It is also essential to monitor the temperature routinely at the nasopharyngeal and bladder level and it is important to control coagulation with rotational thromboelastometry (ROTEM). |
| Databáze: | OpenAIRE |
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