Anesthetic considerations for surgical repair of the thoracic aorta

Aortic aneurysms and dissections may involve the ascending, arch, or descending segments of the thoracic aorta.Surgical repair of the thoracic aorta involves a variety of perioperative approaches and considerations related to the type, location, and extent of thoracic aortic pathology. Anesthesiologists must understand the full scope of these issuesto provide optimal care for patients undergoing thoracic aortic surgeries. Preparing for urgent or emergent thoracic aortic surgery In the clinical presentation of thoracic aortic dissection, leaking aneurysm, or contained traumatic transection, a minimum of two large-bore intravenous (IV) catheters must be placed to provide massive volume resuscitation as needed. Placing an arterial line for continuous blood pressure monitoring should be done as soon as possible to allow optimal hemodynamic management. Tight pharmacologic control of a patient's blood pressure and left ventricular ejection velocity should be initiated to help prevent propagation of aortic dissection or aortic rupture. In transporting patients with known or potential acute aortic syndromes to the operating room (OR), it is essential to be prepared for potential acute clinical deterioration and to have appropriate personnel, equipment, drugs, and monitoring available to be able to rapidly intubate the patient (if the patient is not already intubated) and to initiate needed cardiac and volume resuscitation. This is particularly important to remember if the patient is being transported for further diagnostic tests, such as CT imaging, before coming to the OR. Additional venous access or monitoring lines, such as central venous cathetersor pulmonary arterial catheters, can be placed in the OR or the intensive care unit when time permits.