1
|
Nisi F, Carenzo L, Ruggieri N, Reda A, Pascucci MG, Pignataro A, Civilini E, Piccioni F, Giustiniano E. The anesthesiologist's perspective on emergency aortic surgery: Preoperative optimization, intraoperative management, and postoperative surveillance. Semin Vasc Surg 2023; 36:363-379. [PMID: 37330248 DOI: 10.1053/j.semvascsurg.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 06/19/2023]
Abstract
The management of emergencies related to the aorta requires a multidisciplinary approach involving various health care professionals. Despite technological advancements in treatment methods, the risks and mortality rates associated with surgery remain high. In the emergency department, definitive diagnosis is usually obtained through computed tomography angiography, and management focuses on controlling blood pressure and treating symptoms to prevent further deterioration. Preoperative resuscitation is the main focus, followed by intraoperative management aimed at stabilizing the patient's hemodynamics, controlling bleeding, and protecting vital organs. After the operation, factors such as organ protection, transfusion management, pain control, and overall patient care must be taken into account. Endovascular techniques are becoming more common in surgical treatment, but they also present new challenges in terms of complications and outcomes. It is recommended that patients with suspected ruptured abdominal aortic aneurysms be transferred to facilities with both open and endovascular treatment options and a track record of successful outcomes to ensure the best patient care and long-term results. To achieve optimal patient outcomes, close collaboration and regular case discussions between health care professionals are necessary, as well as participation in educational programs to promote a culture of teamwork and continuous improvement.
Collapse
Affiliation(s)
- Fulvio Nisi
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Luca Carenzo
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Nadia Ruggieri
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Antonio Reda
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | | | - Arianna Pignataro
- Vascular Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Efrem Civilini
- Vascular Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Federico Piccioni
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Enrico Giustiniano
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| |
Collapse
|
2
|
Kilkenny J, Greensmith TSW, Hameed W, Gill S, Hassan S. A Case-Based Overview of the Role of Radiological Imaging in Emergency General Surgery. Cureus 2022; 14:e21986. [PMID: 35282515 PMCID: PMC8906555 DOI: 10.7759/cureus.21986] [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] [Accepted: 02/07/2022] [Indexed: 11/18/2022] Open
Abstract
This article aims to give an overview of some of the common conditions seen in emergency general surgery and the recommended choice of imaging. For junior doctors, choosing the correct imaging modality can be difficult so we aim to provide a summary of the evidence behind radiology for emergency general surgery. Four of the most important acute surgical conditions were chosen, alongside abdominal aortic aneurysm. A literature search was carried out to review the most up-to-date evidence regarding imaging choices. Cases were chosen from everyday practice to put the imaging into context. This article gives an overview of the most common imaging modalities used in emergency general surgery. It can be used by medical students and junior doctors to help understand the reasoning behind imaging choices on the acute surgical take.
Collapse
|
3
|
Martinelli O, Fenelli C, Ben-Hamida JB, Fresilli M, Irace FG, Picone V, Malaj A, Gossetti B, Irace L. One-Year Outcomes after Ruptured Abdominal Aortic Aneurysms Repair: Is Endovascular Aortic Repair the Best Choice? A Single-Center Experience. Ann Vasc Surg 2018; 53:63-69. [DOI: 10.1016/j.avsg.2018.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/12/2017] [Accepted: 04/09/2018] [Indexed: 12/20/2022]
|
4
|
Karabulut A, Aydın S. Simultaneous endovascular repairs of concomitant ruptured abdominal aortic aneurysm and huge silent thoracic aortic aneurysm. Indian Heart J 2016; 68 Suppl 2:S66-S68. [PMID: 27751332 PMCID: PMC5067866 DOI: 10.1016/j.ihj.2016.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 04/21/2016] [Accepted: 05/13/2016] [Indexed: 11/25/2022] Open
Abstract
Ruptured abdominal aortic aneurysm (rAAA) is an emergent condition that carries higher mortality rate. Although there had been development of interventional and surgical technique besides improved critical care, mortality rates were still varied between 35 and 53% in the reported series. Preoperative shock was reported as a major factor predicting mortality rate. Feasibility of simultaneous endovascular repair of rAAA and silent thoracic aortic aneurysm (TAA) is not known. Herein, we aimed to demonstrate the advantage of simultaneous endovascular repair of rAAA and silent TAA in the settling of hemodynamic and neurologic instability. We proposed that simultaneous repair of silent aneurysm would eliminate second procedural risk and also further rupture risk, especially in high-risk patients.
Collapse
Affiliation(s)
- Ahmet Karabulut
- Department of Cardiology, Acıbadem University School of Medicine, Acıbadem Atakent Hospital, Istanbul, Turkey.
| | - Selim Aydın
- Department of Cardiovascular Surgery, Acıbadem Atakent Hospital, Istanbul, Turkey
| |
Collapse
|