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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.

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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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