Canadian Journal of Anesthesia, Vol 32, 73-78, Copyright © 1985 by Canadian Anesthesiologists' Society

Anaesthesia for Aortic Arch Aneurysm Repair: Experience with 17 Patients

¹ Departments of Anesthesiology and Cardiovascular Surgery, State University Hospital, Downstate Medical Center, New York

Address correspondence to: Dr. Pierre A. Casthely, Department of Anesthesiology, State University Hospital, Downstate Medical Center, 450 Clarkson Avenue, Box 6, Brooklyn, New York 11203.

Mortality and morbidity during aortic arch aneurysm repair is high despite improvements in surgical technique which attempt to assure brain protection during surgery. We successfully managed 17 patients using deep hypothermia and circulatory arrest. Anaesthesia consisted of pancuronium, fentanyl, plus isoflurane or halothane if needed. Pulmonary artery and arterial catheters were inserted. Surface cooling was performed followed by core cooling on cardiopulmonary bypass, using a heat exchanger. Total circulatory arrest was performed when esophageal temperature reached 12-14 ° C after previous administration of thiopentone 30 mg·kg^-1, methylprednisolone 2 gm, furosemide 40 mg and mannitol 25 gm. At that time the head was packed in ice and surgical correction performed. Mean arrest time was 36.5 ± 13 minutes at a mean oesophageal temperature of 12.5 ± 0.75° C. No serious, permanent neurological deficit was found. Tracheostomy was required in five patients of whom two had chronic obstructive pulmonary disease (COPD). Two of these patients died of adult respiratory distress syndrome (ARDS) and renal failure. The reported technique is safe and can be easily used in patients undergoing aortic arch aneurysm repair.

Key Words: SURGERY: aortic arch aneurysm repair • ANAESTHETIC TECHNIQUE: hypothermia, circulatory arrest