Awake aortic aneurysm repair in patients with severe pulmonary disease.

Awake aortic aneurysm repair in patients with severe pulmonary disease.

McGregor W E; Koler A J; Labat G C; Perni V; Hirko M K; Rubin J R

American journal of surgery

1999

1999-08

BACKGROUND: We report the use of retroperitoneal aortic aneurysm repair utilizing exclusive regional anesthesia (no intubation or inhalation anesthetic) in high pulmonary risk patients. METHODS: Six patients were retrospectively reviewed. Pulmonary disease was diagnosed by clinical history and pulmonary function tests. Patients received intravenous sedation and regional anesthesia. Retroperitoneal aortoiliac aneurysm repair was performed. RESULTS: All patients used inhaled steroids and albuterol. Three required theophylline and home oxygen. FEV1 = 23% +/- 5% predicted, FVC = 34% +/- 5% predicted, and PO2 = 62 +/- 2 mm Hg. Operative time was 247 +/- 25 minutes. Blood loss was 840 +/- 479 mL. Five of six patients (83%) tolerated awake aneurysm repair and had intensive care unit stays of 2.4 +/- 0.6 days, and postoperative hospital stays of 8.2 +/- 1.8 days. One patient was converted to general anesthesia and had a prolonged hospital stay. CONCLUSIONS: With thorough patient communication, awake retroperitoneal aortic aneurysm repair can be safely performed in select patients with severe pulmonary disease.

*Consciousness; Abdominal/*surgery; Administration; Aged; Albuterol/administration & dosage/therapeutic use; Anesthesia; Aortic Aneurysm; Blood Loss; Bronchodilator Agents/administration & dosage/therapeutic use; Critical Care; Epidural; Forced Expiratory Volume/physiology; General; Home Care Services; Hospitalization; Humans; Hypnotics and Sedatives/administration & dosage; Iliac Aneurysm/*surgery; Inhalation; Intravenous; Length of Stay; Lung Diseases/*complications/drug therapy/therapy; Oxygen Inhalation Therapy; Retroperitoneal Space; Retrospective Studies; Risk Factors; Safety; Steroids/administration & dosage/therapeutic use; Surgical; Theophylline/administration & dosage/therapeutic use; Time Factors; Vital Capacity/physiology

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