Hypothermic circulatory arrest and retrograde cerebral perfusion for aortic surgery at Siriraj Hospital: a preliminary review of anesthetic management.

OBJECTIVE: To evaluate the anesthetic management in patients undergoing aortic surgery cerebral perfusion; with particular emphasis on under hypothemic circulatory arrest and retrograde intraoperative brain protection, blood salvage and postoperative outcomes. MATERIAL AND METHOD: Retrospective case series. Data on medical conditions, anesthesia, surgery and postoperative care from patients who underwent operation between June 1993 and December 1999 were analyzed. RESULTS: There were 53 patients involved in this study. They all received general balanced anesthesia; 70.6 per cent had single-lumen endotracheal intubation, while the remaining required double-lumen endotracheal intubation. The duration of the anesthetic procedure, aortic cross-clamping and circulatory arrest, were 365.58 +/- 89.21, 126.35 +/- 34.64 and 48.35 +/- 19.47 min respectively. The lowest nasopharyngeal and rectal temperature were 17.42 +/- 1.40 degrees C and 21.26 +/- 2.80 degrees C respectively. Thiopental 804.68 +/- 353.93 mg and dexamethasone 14.41 +/- 7.88 mg were administered for brain protection, in addition to retrograde cerebral perfusion; 82.35 per cent received 785.71 +/- 273.86 mg of tranexamic acid and only 23.52 per cent received aprotinin in order to reduce blood loss. However, massive blood replacement therapy was always necessary. In the postoperative period, the patients were ventilated for 39.18 +/- 59.53 h, the length of hospital stay was 14.58 +/- 5.83 d, and the mortality was 13.2 per cent. CONCLUSION: This preliminary data indicate that hypothermic circulatory arrest in aortic surgery is associated with a high mortality rate, despite attempts to provide adequate cerebral protection as well as intraoperative blood salvage.

Pain relief for post thoracotomy.

Fifty-nine patients undergoing thoracotomy were randomly divided into four groups to compare the postoperative analgesic effect of intraoperative intercostal nerve blocks with bupivacaine (group 2),or installation of bupivacaine into the pleural s pace (group 3), or epidermal morphine of 4 mg (group 4), as against a control group given intravenous morphine (group 1). The pain score was evaluated by visual analogue scale (VAS). The additional morphine intravenously administered was required for postoperative pain relief in all groups. Anyhow the group 4 patient had the lowest pain scores during the first 24-hours postoperative period.