Anaes SAQs · Vascular anaesthesia
AAA open repair versus EVAR: anaesthetic decision matrix
Final-examination SAQ for aaa-open-evar.
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ANZCAFRCAEDAICABAFCAI
Prompt
Elective open infrarenal AAA repair. Outline monitoring, clamp and unclamp management, and cardiac risk issues.
Model answer
Monitoring (5). A-line before induction, large-bore access, goal-directed haemodynamics with serial gases — the open infrarenal AAA pathway studied prospectively (40 repairs, balanced versus TIVA).[3]
Clamp/unclamp (5). Cross-clamp ischaemia/reperfusion drives systemic haemodynamic and microcirculatory disturbance; volume/vasopressor readiness before unclamp (readiness taught).[3]
Risk (5). RCRI high-risk surgery; avoid naive high-dose acute beta-blockade per POISE lessons.[1][2]
References3ShowHide
- [1]Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation, 1999.PMID 10477528
- [2]Devereaux PJ, Yang H, Yusuf S, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet, 2008.PMID 18479744
- [3]Loggi S, Mininno N, Damiani E, et al. Changes in the sublingual microcirculation following aortic surgery under balanced or total intravenous anaesthesia: a prospective observational study. BMC Anesthesiol, 2019.PMID 30611197