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Anesthetic Management for Abdominal Aortic Aneurysm Rupture

Department of Anesthesiology and Intensive Care, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia

Received: 21 Sep 2023; Revised: 24 Mar 2024; Published: 31 Mar 2024.
Open Access Copyright 2024 JAI (Jurnal Anestesiologi Indonesia)

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Background: Aortic aneurysm is the thirteenth leading cause of death in the united states. Around 15.000 people died each year because of aortic aneurysm rupture. The mortality rate for this case are still high at around 90%. Patient diagnosed with acute aortic rupture will need an urgent surgery.

Case: A 36-year-old man came with complaints of pain in the waist to back area since 1 week before entering the hospital and worsening 2 days before entering the hospital. Pain is felt intermittent. The pain is sharp and severe when the patient strains. On physical examination found high blood pressure (160/104 mmHg), chest X-ray showed widening of the mediastinum suspected descending aortic aneurysm, CT angiography showed a fusiform type descending aortic aneurysm pars thoracoles, ruptured abdominal aortic aneurysm of juxtarenal fusiform type to the terminal abdominal aorta and hemoperitoneum. The patient underwent repair of an abdominal aortic aneurysm under general anesthesia. After surgery the patient was admitted to the ICU for clinical and hemodynamic monitoring, but the patient's condition in the ICU worsened. The patient experienced acute kidney failure and liver failure, then the patient died on the 10th day after surgery.

Discussion: Surgery for ruptured abdominal aortic aneurysm is associated with high mortality. Even patients who survive the initial procedure are at high risk of complications (such as renal, cardiac, respiratory, haematological, or gastrointestinal failure). The main goal of anesthesia is to maintain anesthesia with cardiovascular stability and normothermia for as long as possible. Minimum standards of monitoring for surgery include electrocardiogram, CVP, arterial line, temperature, and urine output. This operation uses a cell saver machine which functions to collect lost blood, clean the blood and return it to the patient.

Conclusion: Surgery for patients with acute aortic rupture requires complicated and complex anesthetic techniques. This operation requires collaboration and good communication between the surgeon and the anesthesiologist.

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Keywords: abdominal aorta; aneurysm; cell saver machine; general anesthesia; mediastinum

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  1. Subramaniam K., Park K.W., Subramaniam B., Anesthesia and Perioperative Care for Aortic Surgery. Springer, New York, 2011; hal. 1:1-194
  2. Cronenwett JL, Johnston KW, editor. Rutherford’s vascular surgery. 7th ed
  3. Philadelphia: Saunders, an imprint of Elsevier, Inc.;2010
  4. Weintraub NL. Understanding Abdominal Aortic Aneurysm. N Engl J Med
  5. ;361(11):1114–6
  6. Christoph A. Nienaber, Kim A. Eagle. Aortic Dissection: New Frontiers in Diagnosis and Management. Circulation 2003;108;628-635
  7. Lindholm EE. Perioperative aspects of abdominal aortic surgery; focus on choice of anesthetics. Acta Anaesthesiol Scand 2016; 60:411
  8. Gelman S. The pathophysiology of aortic cross-clamping and unclamping. Anesthesiology 1995; 82:1026
  9. Ho P, Ting AC, Cheng SW. Blood loss and transfusion in elective abdominal aortic aneurysm surgery. ANZ J Surg 2004; 74:631
  10. Carless PA, Henry DA, Moxey AJ, et al. Cell salvage for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 2010; :CD001888
  11. Hobson C, Lysak N, Huber M, et al. Epidemiology, outcomes, and management of acute kidney injury in the vascular surgery patient. J Vasc Surg 2018; 68:916
  12. Licker M, Christoph E, Cartier V, et al. Impact of anesthesia technique on the incidence of major complications after open aortic abdominal surgery: a cohort study. J Clin Anesth 2013; 25:296
  13. Woodward G, Howell S. Anesthesia and Perioperative Care for Aortic Surgery. BJA Br J Anaesth. 2013;111(4):682–683. doi: 10.1093/bja/aet314
  14. McGinigle KL, Spangler EL, Pichel AC, et al. Perioperative care in open aortic vascular surgery: A consensus statement by the Enhanced Recovery After Surgery (ERAS) Society and Society for Vascular Surgery. J Vasc Surg. 2022;75(6):1796-1820. doi: 10.1016/j.jvs.2022.01.131
  15. Agarwal S, Kendall J, Quarterman C. Perioperative management of thoracic and thoracoabdominal aneurysms. BJA Educ. 2019;19(4):119-125. doi: 10.1016/j.bjae.2019.01.004
  16. Alwardt CM, Redford D, Larson DF. General anesthesia in cardiac surgery: a review of drugs and practices. J Extra Corpor Technol. 2005;37(2):227-235
  17. Cohn LH, Edmunds LH.. Cardiac Surgery in the Adult. 2nd ed. New York: McGraw-Hill; 2003:403
  18. Lee J, Park KM, Jung S, Cho W, Hong KC, Jeon YS, Cho SG, Lee JB. Occurrences and Results of Acute Kidney Injury after Endovascular Aortic Abdominal Repair? Vasc Specialist Int. 2017 Dec;33(4):135-139. doi: 10.5758/vsi.2017.33.4.135.Epub2017Dec31.PMID:29354623;PMCID:PMC5754070
  19. Sprung J, Levy PJ, Tabares AH, Gottlieb A, Schoenwald PK, Olin JW. Ischemic liver dysfunction after elective repair of infrarenal aortic aneurysm: incidence and outcome. J Cardiothorac Vasc Anesth. 1998 Oct;12(5):507-11. doi: 10.1016/s1053-0770(98)90091-x.PMID:9801968

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