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1.
J Endovasc Ther ; 28(6): 837-843, 2021 Dec.
Article in English | MEDLINE | ID: mdl-34180738

ABSTRACT

INTRODUCTION: Endovascular repair of thoracoabdominal aortic aneurysms carries a risk of spinal cord ischemia, the causes of which remain uncertain. We hypothesized that local anesthesia (LA) with conscious sedation could abrogate the potential suppressive cardiovascular effects of general anesthesia (GA) and facilitate intraoperative monitoring of neurological function. Here, we examine the feasibility of this technique during fenestrated (FEVAR) or branched endovascular aortic repair (BEVAR). MATERIALS AND METHODS: Consecutive patients undergoing FEVAR or BEVAR under LA and conscious sedation by a team at a single center were analyzed. Patients received conscious sedation using intravenous remifentanil and propofol infusions in conjunction with a local anesthetic agent. No patient had a prophylactic spinal drain inserted. Outcome measures included conversion to GA, need for vasopressors and/or spinal drainage, length of stay, complications, and patient survival. RESULTS: A total of 44 patients underwent FEVAR or BEVAR under LA and conscious sedation. The cohort included thoracoabdominal aortic aneurysms (n=41) and pararenal aneurysms treated with endografts covering the supraceliac segment (n=3). Four patients (9%) required conversion to GA at a median operative duration of 198 minutes (range 97-495 minutes). Vasopressors were required intraoperatively in 3 of the cases that were converted to GA. No patient developed spinal cord ischemia and none had insertion of a spinal drain. The median hospital length of stay was 4 days (range 2-41 days). Postoperative delirium and hospital-acquired pneumonia was seen in 7% of patients. All patients survived to 30 days, with 95% alive at a median follow-up of 15 months (range 3-26 months). CONCLUSION: LA and conscious sedation is a feasible anesthetic technique for the endovascular repair of thoracoabdominal aortic aneurysms.


Subject(s)
Aortic Aneurysm, Abdominal , Aortic Aneurysm, Thoracic , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Anesthesia, Local/adverse effects , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Conscious Sedation/adverse effects , Endovascular Procedures/adverse effects , Humans , Retrospective Studies , Risk Factors , Spinal Cord , Treatment Outcome
3.
Ann Card Anaesth ; 20(4): 453-455, 2017.
Article in English | MEDLINE | ID: mdl-28994685

ABSTRACT

Rhabdomyolysis is the result of skeletal muscle tissue injury and is characterized by elevated creatine kinase levels, muscle pain, and myoglobinuria. It is caused by crush injuries, hyperthermia, drugs, toxins, and abnormal metabolic states. This is often difficult to diagnose perioperatively and can result in renal failure and compartment syndrome if not promptly treated. We report a rare case of inadvertent rhabdomyolysis and compartment syndrome in a bodybuilder undergoing minimally invasive cardiac surgery. The presentation, differential diagnoses, and management are discussed. Hyperkalemia may be the first presenting sign. Early recognition and management are essential to prevent life-threatening complications.


Subject(s)
Cardiac Surgical Procedures/adverse effects , Compartment Syndromes/etiology , Minimally Invasive Surgical Procedures/adverse effects , Rhabdomyolysis/etiology , Weight Lifting , Adult , Anesthesia , Aortic Valve/surgery , Aortic Valve Insufficiency/surgery , Humans , Hyperkalemia/etiology , Male
4.
Ann Thorac Surg ; 101(3): e71-3, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26897234

ABSTRACT

A 75-year-old man previously underwent pneumonectomy for lung cancer. He subsequently had colorectal adenocarcinoma, and resection of metastases from his remaining lung was performed. Venovenous extracorporeal membrane oxygenation was used for perioperative respiratory support to facilitate intraoperative deflation of the remaining lung and optimization of the surgical field. Venovenous extracorporeal membrane oxygenation was continued postoperatively, allowing immediate extubation, thus avoiding strain on suture lines. Advantages, and potential risks, of venovenous extracorporeal membrane oxygenation for thoracic surgery are discussed.


Subject(s)
Adenocarcinoma/surgery , Colorectal Neoplasms/pathology , Extracorporeal Membrane Oxygenation/methods , Lung Neoplasms/surgery , Perioperative Care/methods , Pneumonectomy/methods , Adenocarcinoma/diagnosis , Adenocarcinoma/secondary , Aged , Humans , Lung Neoplasms/diagnosis , Lung Neoplasms/secondary , Male , Reoperation , Tomography, X-Ray Computed
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