Anesthesia And Controlled Hypotension For Endovascular Stent Graft Repair Of Aortic Dissecting Aneurysm

ObjectiveTo explore the anesthetic management and key point and controlled hypotension of patients with aortic dissecting aneurysm underwent endovascular stent graft repair.MethodsEighteen patients with aortic dissecting aneurysm of Debakey III type were underwent endovascular stent graft repair under general anesthesia and controlled hypotension. The total intravenous anesthesia was adopted with propofol, remifentanil and vecuronium bromide mostly. The radial arterial pressure, electrocardiogram (ECG), pulse oxygen saturation (SpO2), central venous pressure(CVP), partial pressure of carbon dioxide in end expiratory gas(PETCO2) and urine volume were observed continuously, And the systolic blood pressure(SBP), mean arterial pressure(MAP) and heart rate(HR) were recorded in the following period, pre-anesthesia induction, post-anesthesia induction, start of operation, pre-release of endovascular stent, release of stent post-operation and the end of operation. Meanwhile, the time of operation and analepsia were recorded. An intravenous infusion of sodium nitroprusside was given by 0.5-5.0μg·kg-1·min-1 to regulate systolic pressure about 120mmHg during operation, and maintain systolic pressure 70-90mmHg during release of the stent. Controlled respiration was stopped to simulate breathholding in the injection of constrast medium and digital scissors-shadow. Patient controlled intravenous analgesia(PCIA) with sulfentanyl was adopted in the patient with pain after operation,ResultsThe anesthetic effect of all patients was very good and the hemodynamics was steady. The systolic blood pressure(SBP) and mean arterial pressure(MAP) were significantly degraded in the release of stent with controlled hypotension (P<0.05), and in other time SBP and MAP were not significant difference compare with pre-anesthesia induction. HR was not significant difference compare with pre-anesthesia induction in each period. Anesthesia and operation were successful in all patients, it was confirmed by vasography that the endovascular stent was graft exactly, the orificium fistulae of Aortic tunica intima was envelop, and the true lumen of arteriae aorta recovered. No adverse effects occurred in operation period. The time of operation was 148.16±23.25min, the patients waked up in 5-20min aftert operation and returned quietly to Cardiac Care Unit after extubate. All patients recovered well, no adverse effects and complications associated with anesthesia occurred in any patient. Two patients occurred back pain and PCIA with sulfentanyl was adopted after excluded other cause, then the pain was relieved.ConclusionsThe total intravenous anesthesia with propofol, remifentanil and vecuronium combined controlled hypotension was a satisfactory anesthetic technique for endovascular stent graft repair of aortic dissecting aneurysm. The consummate preoperative prepare, election of anesthesia method and drug were important foundation of anesthesia. The control of blood pressure and heart rate in the anesthesia induction, release of endovascular stent and analepsia, and the treatment of post-operation pain, were key point of anesthetic management.