Epidural anesthesia as an adjunct to retroperitoneal aortic surgery

Article Abstract:

It has been suggested that for surgery performed on the aorta, the main trunk of the systemic arterial circulation, a retroperitoneal rather than a transperitoneal approach may be associated with shorter hospital stays and decreased mortality. A retroperitoneal approach goes behind the peritoneal cavity (the space between the layer of peritoneum covering the abdominal wall and that covering the abdominal organs), whereas a transperitoneal approach enters into the peritoneal cavity. Epidural anesthesia (injection of a local anesthetic into the epidural space of the spine in order to achieve regional anesthesia) has been shown to be effective in surgery on the blood vessels of the legs. A study was undertaken to determine if the advantages of both the retroperitoneal approach and epidural anesthesia could be combined successfully. There were 57 patients who were undergoing elective aortic surgery included in this study; 33 had the retroperitoneal approach and 24 had the transperitoneal approach. In the retroperitoneal group, 10 patients had epidural anesthesia, three had general anesthesia and 20 had a combination of epidural and general anesthesia. In the transperitoneal group, 21 patients had general anesthesia and three had the combination. The two groups were evaluated on morbidity, duration of ileus (obstruction of the intestine), pulmonary complications, and number of days spent in the intensive care unit. There were no significant differences between the transperitoneal and retroperitoneal groups. For low-risk retroperitoneal patients, morbidity was significantly reduced when a combination of epidural and general anesthesia was used. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Peridural anesthesia, Epidural anesthesia

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Staged repair of interrupted aortic arch with ventricular septal defect compared with primary repair in infancy

Article Abstract:

The aortic arch is where the largest artery leading directly out of the top of the heart curves around behind the heart to proceed downwards to bring oxygenated blood to areas of the body below the heart. An interrupted aortic arch is a defect which is almost always fatal if not recognized and treated early. The associated damaged tissue inside the heart often leads to death if only the arch defect is repaired. Some patients with interrupted aortic arch have simultaneous repair of the arch and the damaged tissues inside the heart in infancy. The improved survival rates of these patients compared with those who only had the arch repaired has been attributed to the simultaneous surgical correction of both problems. Nine patients suffered from both an interrupted aortic arch and a defect of the wall which separates the two main pumping chambers of the heart (ventricular septal defect), and three of them had abnormalities of the heart and largest blood vessels due to thyroid gland abnormalities (DiGeorge's syndrome). All patients underwent surgical repair of the interrupted aortic arch at an average age of 18 days. One out of the nine patients died from the operation. At an average age of 18 months, 8 patients had their ventricular septal defect repaired. One died 5 months after this operation. Thus repair of an interrupted aortic arch with an associated ventricular septal defect can be performed in stages with results as good as those resulting from simultaneous repair. Improved survival from either approach is most likely due to improved stabilization of the patient's condition before and after surgery particularly by administration of prostaglandin E (a body chemical which mediates various processes).

Health aspects, Care and treatment, Abnormalities, Infants, Prostaglandins, Ventricular septal defects, Heart septum

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Division of the left renal vein during aortic surgery

Article Abstract:

Visibility of and access to the abdominal aorta in the area of the kidney can be enhanced by ligation and division of the left renal vein (LRV). However, this can be done only if there is sufficient collateral venous circulation to maintain adequate blood flow while the LRV is divided. It has been recommended that the pressure in the LRV be measured, and if it is found to be high, that the division not be performed. Data are reported on animal and human subjects who underwent abdominal aortic surgery. There were 67 patients who underwent division of the LRV during this surgery. This group accounted for 10 percent of patients having abdominal aortic aneurysm surgery, and 1 percent of those undergoing reconstruction for aortoiliac disease. LRV pressures were measured in 44 patients and were found to be less than or equal to 60 cm water. These patients also showed only moderate swelling of the vein. A LRV sump pressure equal to or greater than 50 cm water and extreme venous dilation after test clamping was a contraindication to LRV division in other patients. It is concluded that a LRV sump pressure less than 50 to 60 cm water appears to be an indication for LRV division during aortic surgery. A pressure greater than 50 to 60 cm water favors avoidance of LRV division unless absolutely necessary, and then only if the opposite kidney is known to be functioning adequately. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Kidneys, Blood vessels, Kidney, Venous pressure, Abdominal aorta

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