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Budiansky AS, Hjartarson EP, Polis T, Krolczyk G, Sinclair J. Emerging anesthesia techniques for managing intraoperative rupture of cerebral aneurysms. Int Anesthesiol Clin 2023; 61:64-72. [PMID: 37218511 DOI: 10.1097/aia.0000000000000400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Adele S Budiansky
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Emma P Hjartarson
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Tomasz Polis
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Gregory Krolczyk
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - John Sinclair
- Division of Neurosurgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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2
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Gottardi R, Berger T, Voetsch A, Winkler A, Krombholz-Reindl P, Farkouh A, Kondov S, Rylski B, Sodian R, Czerny M. What Is the Best Method to Achieve Safe and Precise Stent-Graft Deployment in Patients Undergoing TEVAR? Thorac Cardiovasc Surg 2020; 69:357-361. [DOI: 10.1055/s-0040-1710581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AbstractThoracic endovascular aortic repair (TEVAR) for aortic pathologies requires sufficient landing zone of ideally more than 25 mm for safe anchoring of the stent-graft and prevention of endoleaks. In the aortic arch and at the thoracoabdominal transition, landing zone length is usually limited by the offspring of the major aortic side-branches. Exact deployment of the stent-graft to effectively use the whole length of the landing zone and to prevent occlusion of one of the side-branches is key to successful TEVAR. There are numerous techniques described to lower blood pressure and to reduce or eliminate aortic impulse to facilitate exact deployment of stent-grafts including pharmacologic blood pressure lowering, adenosine-induced asystole, inflow occlusion, and rapid pacing. Aim of this review was to assess the current literature to identify which of the techniques is best suited to prevent displacement and allow for precise placement of the stent-graft and safe balloon-molding.
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Affiliation(s)
- Roman Gottardi
- Department of Cardiac, Thoracic and Vascular Surgery, MediClin Heart Institute Lahr/Baden, Germany
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
| | - Tim Berger
- Department of Cardiovascular Surgery, University Heart Center Freiburg, University Freiburg, Bad Krozingen, Germany
- Department of Cardiovascular Surgery, Medical Faculty of the Albert Ludwigs-University Freiburg, Freiburg, Baden Württemberg, Germany
| | - Andreas Voetsch
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
| | - Andreas Winkler
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
| | - Philipp Krombholz-Reindl
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
| | - Andre Farkouh
- Division of Clinical Pharmacy and Diagnostics, Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Stoyan Kondov
- Department of Cardiovascular Surgery, University Heart Center Freiburg, University Freiburg, Bad Krozingen, Germany
- Department of Cardiovascular Surgery, Medical Faculty of the Albert Ludwigs-University Freiburg, Freiburg, Baden Württemberg, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, University Heart Center Freiburg, University Freiburg, Bad Krozingen, Germany
- Department of Cardiovascular Surgery, Medical Faculty of the Albert Ludwigs-University Freiburg, Freiburg, Baden Württemberg, Germany
| | - Ralf Sodian
- Department of Cardiac, Thoracic and Vascular Surgery, MediClin Heart Institute Lahr/Baden, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg, University Freiburg, Bad Krozingen, Germany
- Department of Cardiovascular Surgery, Medical Faculty of the Albert Ludwigs-University Freiburg, Freiburg, Baden Württemberg, Germany
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3
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Erben Y, Oderich GS, Verhagen HJ, Witsenburg M, van den Hoven AT, Debus ES, Kölbel T, Arko FR, Torsello GB, Torsello GF, Lawrence PF, Harlander-Locke MP, Bacharach JM, Jordan WD, Eskandari MK, Hagler DJ. Multicenter experience with endovascular treatment of aortic coarctation in adults. J Vasc Surg 2019; 69:671-679.e1. [DOI: 10.1016/j.jvs.2018.06.209] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 06/25/2018] [Indexed: 11/26/2022]
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4
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The Use of Adenosine to Enable Safe Implantation of Transcatheter Tricuspid Valve. Case Rep Cardiol 2018; 2017:2760580. [PMID: 29348945 PMCID: PMC5733988 DOI: 10.1155/2017/2760580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 09/14/2017] [Indexed: 11/17/2022] Open
Abstract
High precision is necessary during percutaneous transcatheter heart valve implantation. The precision of the implantation has been established by increasing the heart rate (usually to 200 beats per minute) to the point of significantly reduced cardiac output and thus minimizing valve movement. Routinely, this tachycardia is induced by rapid pacing. Here we report a case of failure to pace during valve-in-valve (VIV) Edwards Sapien XT implantation in the tricuspid valve position. Transient cardiac arrest was induced by intravenous adenosine injection enabling accurate valve implantation.
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Boufi M, Guivier-Curien C, Dona B, Loundou A, Deplano V, Boiron O, Hartung O, Alimi Y. Risk Factor Analysis for the Mal-Positioning of Thoracic Aortic Stent Grafts. Eur J Vasc Endovasc Surg 2016; 52:56-63. [DOI: 10.1016/j.ejvs.2016.03.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/19/2016] [Indexed: 10/21/2022]
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6
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Nauta FJH, Trimarchi S, Kamman AV, Moll FL, van Herwaarden JA, Patel HJ, Figueroa CA, Eagle KA, Froehlich JB. Update in the management of type B aortic dissection. Vasc Med 2016; 21:251-63. [DOI: 10.1177/1358863x16642318] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Stanford type B aortic dissection (TBAD) is a life-threatening aortic disease. The initial management goal is to prevent aortic rupture, propagation of the dissection, and symptoms by reducing the heart rate and blood pressure. Uncomplicated TBAD patients require prompt medical management to prevent aortic dilatation or rupture during subsequent follow-up. Complicated TBAD patients require immediate invasive management to prevent death or injury caused by rupture or malperfusion. Recent developments in diagnosis and management have reduced mortality related to TBAD considerably. In particular, the introduction of thoracic stent-grafts has shifted the management from surgical to endovascular repair, contributing to a fourfold increase in early survival in complicated TBAD. Furthermore, endovascular repair is now considered in some uncomplicated TBAD patients in addition to optimal medical therapy. For more challenging aortic dissection patients with involvement of the aortic arch, hybrid approaches, combining open and endovascular repair, have had promising results. Regardless of the chosen management strategy, strict antihypertensive control should be administered to all TBAD patients in addition to close imaging surveillance. Future developments in stent-graft design, medical therapy, surgical and hybrid techniques, imaging, and genetic screening may improve the outcomes of TBAD patients even further. We present a comprehensive review of the recommended management strategy based on current evidence in the literature.
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Affiliation(s)
- Foeke JH Nauta
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy
- Cardiovascular Center, University of Michigan Health System, Ann Arbor, MI, USA
| | - Santi Trimarchi
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy
| | - Arnoud V Kamman
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy
| | - Frans L Moll
- Vascular Surgery Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joost A van Herwaarden
- Vascular Surgery Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - C Alberto Figueroa
- Departments of Biomedical Engineering and Surgery, University of Michigan, USA
| | - Kim A Eagle
- Cardiovascular Center, University of Michigan Health System, Ann Arbor, MI, USA
| | - James B Froehlich
- Cardiovascular Center, University of Michigan Health System, Ann Arbor, MI, USA
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Tagarakis GL, Whitlock RP, Gutsche JT, Diegeler A, Patel PA, Daskalopoulos ME, Vernick WJ, Anastasiadis K, Augoustides JG. New frontiers in aortic therapy: focus on deliberate hypotension during thoracic aortic endovascular interventions. J Cardiothorac Vasc Anesth 2014; 28:843-7. [PMID: 24746338 DOI: 10.1053/j.jvca.2014.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Georgios L Tagarakis
- Department of Surgery, AHEPA Hospital, Aristotle University, Thessaloniki, Greece
| | | | - Jacob T Gutsche
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Prakash A Patel
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - William J Vernick
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - John G Augoustides
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Dvir D, Badr S, Pichard AD. Adenosine-induced temporary block to improve accuracy of ostial coronary stent implantation: adenosine to improve stent implantation accuracy. Catheter Cardiovasc Interv 2014; 83:E61-3. [PMID: 23592591 DOI: 10.1002/ccd.24941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 02/11/2013] [Accepted: 04/07/2013] [Indexed: 11/06/2022]
Abstract
Implantation of coronary stents should be performed with high precision to ensure optimal clinical results. In some clinical conditions, during the cardiac cycle, significant movement of the predeployed stent may impact its implantation accuracy. We describe a case in which a patient had a short ostial left anterior descending artery stenosis and hyperkinetic left ventricle, resulting in significant movement of the stent inside the vessel lumen during the cardiac cycle. Intracoronary adenosine was used to create temporary heart block to enable accurate stent implantation.
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Affiliation(s)
- Danny Dvir
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
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Jazaeri O, Gupta R, Rochon PJ, Reece TB. Endovascular approaches and perioperative considerations in acute aortic dissection. Semin Cardiothorac Vasc Anesth 2011; 15:141-62. [PMID: 22194281 DOI: 10.1177/1089253211425424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aortic dissections remain complicated management issues both in the acute setting and in the chronic setting. Acute problems revolve around malperfusion syndromes or rupture, whereas chronic issues progress from the development of aneurysms in the residual dissected aorta. Endovascular approaches to dealing with these difficult situations are being used more frequently to treat acute issues in type B dissections and prevent secondary complications in type A dissections that may require significant intervention in the future. This article discusses the endovascular approaches employed in the care of acute dissections with particular attention toward the anesthetic considerations involved in these challenging cases.
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Affiliation(s)
- Omid Jazaeri
- University of Colorado Denver, Aurora, CO 80045, USA
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Bendok BR, Gupta DK, Rahme RJ, Eddleman CS, Adel JG, Sherma AK, Surdell DL, Bebawy JF, Koht A, Batjer HH. Adenosine for Temporary Flow Arrest During Intracranial Aneurysm Surgery: A Single-Center Retrospective Review. Neurosurgery 2011; 69:815-821. [DOI: 10.1227/neu.0b013e318226632c] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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11
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Lyons O, Clough R, Patel A, Saha P, Carrell T, Taylor P. Endovascular Management of Stanford Type A Dissection or Intramural Hematoma With a Distal Primary Entry Tear. J Endovasc Ther 2011; 18:591-600. [DOI: 10.1583/11-3468.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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12
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Endovascular Therapy of Ascending Thoracic Aorta. Ann Vasc Surg 2010; 24:696-8. [DOI: 10.1016/j.avsg.2010.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Revised: 12/09/2009] [Accepted: 01/10/2010] [Indexed: 11/18/2022]
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Juszkat R, Kulesza J, Zarzecka A, Jemielity M, Staniszewski R, Majewski W. New technique for the preservation of the left common carotid artery in zone 2a endovascular repair of thoracic aortic aneurysm. Cardiovasc Intervent Radiol 2010; 34:67-73. [PMID: 20425111 DOI: 10.1007/s00270-010-9858-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Accepted: 03/23/2010] [Indexed: 11/26/2022]
Abstract
To describe a technique for the preservation of the left common carotid artery (CCA) in zone 2 endovascular repair of thoracic aortic aneurysm. This technique involves the placement of a guide wire into the left CCA via the right brachial artery before stent graft deployment to enable precise visualization and protection of the left CCA during the whole procedure. Of the 107 patients with thoracic endovascular aortic repair in our study, 32 (30%) had the left subclavian artery intentionally covered (landing zone 2). Eight (25%) of those 32 had landing zone 2a-the segment distally the origin of the left CCA, halfway between the origin of the left CCA and the left subclavian artery. In all patients, a guide wire was positioned into the left CCA via the right brachial artery before stent graft deployment. It is a retrospective study in design. In seven patients, stent grafts were positioned precisely. In the remaining patient, the positioning was imprecise; the origin of the left CCA was partially covered by the graft. A stent was implanted into the left CCA to restore the flow into the vessel. All procedures were performed successfully. The technique of placing a guide wire into the left CCA via the right brachial artery before stent graft deployment is a safe and effective method that enables the precise visualization of the left CCA during the whole procedure. Moreover, in case of inadvertent complete or partial coverage of the origin of the left CCA, it supplies safe and quick access to the artery for stent implantation.
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Affiliation(s)
- Robert Juszkat
- Department of Radiology, Poznań University of Medical Sciences, Szpital Kliniczny nr 1, Ul. Długa ½, 61-848, Poznan, Poland.
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Abstract
Over decades, anesthesiologists have used intravenous adenosine as mainstay therapy for diagnosing or treating supraventricular tachycardia in the perioperative setting. More recently, specific adenosine receptor therapeutics or gene-targeted mice deficient in extracellular adenosine production or individual adenosine receptors became available. These models enabled physicians and scientists to learn more about the biologic functions of extracellular nucleotide metabolism and adenosine signaling. Such functions include specific signaling effects through adenosine receptors expressed by many mammalian tissues; for example, vascular endothelia, myocytes, hepatocytes, intestinal epithelia, or immune cells. At present, pharmacological approaches to modulate extracellular adenosine signaling are evaluated for their potential use in perioperative medicine, including attenuation of acute lung injury; renal, intestinal, hepatic and myocardial ischemia; or vascular leakage. If these laboratory studies can be translated into clinical practice, adenosine receptor-based therapeutics may become an integral pharmacological component of daily anesthesiology practice.
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Knapp J, Bernhard M, Rauch H, Hyhlik-Dürr A, Böckler D, Walther A. [Anesthesiologic procedure for elective aortic surgery]. Anaesthesist 2009; 58:1161-82. [PMID: 19907924 DOI: 10.1007/s00101-009-1630-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Aortic aneurysms are frequent in the elderly who often suffer from relevant co-morbidities. In Germany it is estimated that approximately 250,000 patients suffer from an aortic aneurysm. Due to the high risk of cardiac or pulmonary complications operative management poses a challenge to the anesthesiologist. Especially hemodynamic management during aortic cross-clamping requires anesthesiologic know-how and an anticipatory use of vasodilators and catecholamines. Furthermore, the anesthesiologist has to protect renal function. In order to avoid paraplegia due to spinal ischemia cerebrospinal fluid drainage may be necessary in patients with aneurysms of the thoracic aorta. In recent years endovascular repair of aortic aneurysms has been established in addition to conventional open surgery. As a consequence in some patients aortic surgery can be performed under regional or local anesthesia. In special cases thoracic endovascular repair requires a medicinal induction of heart arrest or the reduction of aortic blood flow by overpacing.
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Affiliation(s)
- J Knapp
- Klinik für Anaesthesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
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Dagenais F, Dumont É, Voisine P. Intramural Hematoma of the Arch and Ascending Aorta Owing to Acute Aortic Syndrome of the Descending Aorta:To Stent or Not to Stent? J Endovasc Ther 2008; 15:544-9. [DOI: 10.1583/08-2468.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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