Skip to main content
SpringerLink
Log in

Anästhesiologisches Management des abdominellen Aortenaneurysmas

Anesthetic management of abdominal aortic aneurysms

  • Leitthema
  • Published:
Gefässchirurgie Aims and scope Submit manuscript

Zusammenfassung

Der folgende Artikel beschreibt spezielle Aspekte des anästhesiologischen Vorgehens im Rahmen von elektiven sowie notfallmäßigen Operationen abdomineller Aortenaneurysmen, die im klinischen Alltag häufig zu Unsicherheiten und Diskussionen führen. Beginnend von den präoperativen Vorbereitungen des Patienten und der Auswahl des idealen Anästhesieverfahrens, über den Sinn von zusätzlichem intraoperativem Monitoring bis hin zum intraoperativen Management der Hämodynamik und der Blutgerinnung sowie den Möglichkeiten der Nephroprotektion und der notfallmäßigen Versorgung des Patienten mit rupturiertem Aortenaneurysma wird die aktuelle Studienlage dargestellt. Soweit wie möglich werden daraus Empfehlungen für eine optimale anästhesiologische Therapie abgeleitet.

Abstract

The following article describes several aspects of the anesthetic management of patients presenting for elective or emergency surgery of an abdominal aortic aneurysm that frequently lead to uncertainties and discussions in the clinical routine. We present the current state of relevant studies and guidelines regarding the preoperative evaluation, the choice of the ideal anesthetic technique, the significance of additional intraoperative monitoring, hemodynamic and coagulation management as well as possible options of nephroprotection and the anesthetic management of ruptured abdominal aortic aneurysms. If possible, some recommendations for the optimal anesthetic management of these patients are derived from the results of current studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Brimacombe J, Berry A (1993) A review of anaesthesia for ruptured abdominal aortic aneurysm with special emphasis on preclamping fluid resuscitation. Anaesth Intensive Care 21:311–323

    CAS  PubMed  Google Scholar 

  2. Group GTC, Lewis SC, Warlow CP et al (2008) General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial. Lancet 372:2132–2142

    Article  Google Scholar 

  3. Kristensen SD, Knuuti J, Saraste A et al (2014) 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: the Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur J Anaesthesiol 31:517–573

    Article  PubMed  Google Scholar 

  4. DGAI, DGCH, DGIM. (2017) Präoperative Evaluation erwachsener Patienten vor elektiven, nicht herz-thoraxchirurgischen Eingriffen. Anästh Intensivmed 58:349–364

    Google Scholar 

  5. London MJ, Hur K, Schwartz GG et al (2013) Association of perioperative beta-blockade with mortality and cardiovascular morbidity following major noncardiac surgery. JAMA 309:1704–1713

    Article  CAS  PubMed  Google Scholar 

  6. Sanfilippo F, Santonocito C, Foex P (2014) Use of beta-blockers in non-cardiac surgery: an open debate. Minerva Anestesiol 80:482–494

    CAS  PubMed  Google Scholar 

  7. Group PS, Devereaux PJ, Yang H et al (2008) Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 371:1839–1847

    Article  Google Scholar 

  8. Wallace AW, Au S, Cason BA (2011) Perioperative beta-blockade: atenolol is associated with reduced mortality when compared to metoprolol. Anesthesiology 114:824–836

    Article  CAS  PubMed  Google Scholar 

  9. Ashes C, Judelman S, Wijeysundera DN et al (2013) Selective beta1-antagonism with bisoprolol is associated with fewer postoperative strokes than atenolol or metoprolol: a single-center cohort study of 44,092 consecutive patients. Anesthesiology 119:777–787

    Article  CAS  PubMed  Google Scholar 

  10. Turan A, Babazade R, Kurz A et al (2016) Clonidine does not reduce pain or opioid consumption after noncardiac surgery. Anesth Analg 123:749–757

    Article  CAS  PubMed  Google Scholar 

  11. Waurick K, Riess H, Van Aken H, Kessler P, Gogarten W, Volk T (2014) Rückenmarksnahe Regionalanästhesien und Thrombembolieprophylaxe/antithrombotische Medikation. Anästh Intensivmed 55:464–492

    Google Scholar 

  12. Werawatganon T, Charuluxanun S (2005) Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004088.pub2

    PubMed  Google Scholar 

  13. Bardia A, Sood A, Mahmood F et al (2016) Combined epidural-general anesthesia vs general anesthesia alone for elective abdominal aortic aneurysm repair. JAMA Surg 151:1116–1123

    Article  PubMed  Google Scholar 

  14. Guay J, Kopp S (2016) Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD005059.pub4

    Google Scholar 

  15. Fleisher LA, Fleischmann KE, Auerbach AD et al (2014) 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol 64:e77–e137

    Article  PubMed  Google Scholar 

  16. Ruppert V, Leurs LJ, Steckmeier B et al (2006) Influence of anesthesia type on outcome after endovascular aortic aneurysm repair: an analysis based on EUROSTAR data. J Vasc Surg 44:16–21 (discussion 21)

    Article  PubMed  Google Scholar 

  17. Edwards MS, Andrews JS, Edwards AF et al (2011) Results of endovascular aortic aneurysm repair with general, regional, and local/monitored anesthesia care in the American College of Surgeons National Surgical Quality Improvement Program database. J Vasc Surg 54:1273–1282

    Article  PubMed  PubMed Central  Google Scholar 

  18. Karthikesalingam A, Thrumurthy SG, Young EL et al (2012) Locoregional anesthesia for endovascular aneurysm repair. J Vasc Surg 56:510–519

    Article  PubMed  Google Scholar 

  19. IMPROVE trial investigators, Powell JT, Hinchliffe RJ et al (2014) Observations from the IMPROVE trial concerning the clinical care of patients with ruptured abdominal aortic aneurysm. Br J Surg 101:216–224 (discussion 224)

    Article  PubMed Central  Google Scholar 

  20. Hainer C, Bernhard M, Scheuren K et al (2006) Echocardiography during acute hemodynamic instability. Anaesthesist 55:1117–1131 (quiz 1132.)

    Article  CAS  PubMed  Google Scholar 

  21. Siddiqi N, Harrison JK, Clegg A et al (2016) Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD005563.pub3

    Google Scholar 

  22. Adesanya A, Rosero E, Timaran C et al (2008) Intraoperative fluid restriction predicts improved outcomes in major vascular surgery. Vasc Endovascular Surg 42:531–536

    Article  PubMed  Google Scholar 

  23. Moll FL, Powell JT, Fraedrich G et al (2011) Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg 41(Suppl 1):S1–S58

    Article  PubMed  Google Scholar 

  24. Hilbert-Carius P, Wurmb T, Lier H et al (2017) Care for severely injured persons : update of the 2016 S3 guideline for the treatment of polytrauma and the severely injured. Anaesthesist 66:195–206

    Article  CAS  PubMed  Google Scholar 

  25. Dick F, Erdoes G, Opfermann P et al (2013) Delayed volume resuscitation during initial management of ruptured abdominal aortic aneurysm. J Vasc Surg 57:943–950

    Article  PubMed  Google Scholar 

  26. Hinchliffe RJ, Powell JT (2013) Improving the outcomes from ruptured abdominal aortic aneurysm: interdisciplinary best practice guidelines. Ann R Coll Surg Engl 95:96–97

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Hope K, Nickols G, Mouton R (2016) Modern anesthetic management of ruptured abdominal aortic aneurysms. J Cardiothorac Vasc Anesth 30:1676–1684

    Article  PubMed  Google Scholar 

  28. Erbel R, Aboyans V, Boileau C et al (2014) 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 35:2873–2926

    Article  PubMed  Google Scholar 

  29. CRASH-2 trial collaborators, Shakur H, Roberts I et al (2010) Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 376:23–32

    Article  Google Scholar 

  30. Safi HJ, Harlin SA, Miller CC et al (1996) Predictive factors for acute renal failure in thoracic and thoracoabdominal aortic aneurysm surgery. J Vasc Surg 24:338–344 (discussion 344–335)

    Article  CAS  PubMed  Google Scholar 

  31. O’Connor CJ, Rothenberg DM (1995) Anesthetic considerations for descending thoracic aortic surgery: part II. J Cardiothorac Vasc Anesth 9:734–747

    Article  PubMed  Google Scholar 

  32. Alpert RA, Roizen MF, Hamilton WK et al (1984) Intraoperative urinary output does not predict postoperative renal function in patients undergoing abdominal aortic revascularization. Surgery 95:707–711

    CAS  PubMed  Google Scholar 

  33. Sugimoto M, Takahashi N, Niimi K et al (2017) Long-term fate of renal function after open surgery for juxtarenal and pararenal aortic aneurysm. J Vasc Surg. https://doi.org/10.1016/j.jvs.2017.07.121

    PubMed  Google Scholar 

  34. Godet G, Fleron MH, Vicaut E et al (1997) Risk factors for acute postoperative renal failure in thoracic or thoracoabdominal aortic surgery: a prospective study. Anesth Analg 85:1227–1232

    Article  CAS  PubMed  Google Scholar 

  35. Gelman S, Reves JG, Fowler K et al (1983) Regional blood flow during cross-clamping of the thoracic aorta and infusion of sodium nitroprusside. J Thorac Cardiovasc Surg 85:287–291

    CAS  PubMed  Google Scholar 

  36. Nicholson ML, Baker DM, Hopkinson BR et al (1996) Randomized controlled trial of the effect of mannitol on renal reperfusion injury during aortic aneurysm surgery. Br J Surg 83:1230–1233

    Article  CAS  PubMed  Google Scholar 

  37. Lassnigg A, Donner E, Grubhofer G et al (2000) Lack of renoprotective effects of dopamine and furosemide during cardiac surgery. J Am Soc Nephrol 11:97–104

    CAS  PubMed  Google Scholar 

  38. Mahesh B, Yim B, Robson D et al (2008) Does furosemide prevent renal dysfunction in high-risk cardiac surgical patients? Results of a double-blinded prospective randomised trial. Eur J Cardiothorac Surg 33:370–376

    Article  PubMed  Google Scholar 

  39. Yeung KK, Tangelder GJ, Fung WY et al (2010) Open surgical repair of ruptured juxtarenal aortic aneurysms with and without renal cooling: observations regarding morbidity and mortality. J Vasc Surg 51:551–558

    Article  PubMed  Google Scholar 

  40. Yeung KK, Groeneveld M, Lu JJ et al (2016) Organ protection during aortic cross-clamping. Best Pract Res Clin Anaesthesiol 30:305–315

    Article  PubMed  Google Scholar 

  41. Vascular Society of Great Britain and Ireland: Best practice guidelines for the management and transfer of patients with a diagnosis of ruptured abdominal aortic aneurysm to a specialist vascular centre. [cited 20.12.2017] Available from: https://www.rcem.ac.uk/docs/College%20Guidelines/5z8.%20Management%20and%20Transfer%20of%20Patients%20with%20a%20diagnosis%20of%20Ruptured%20Abdominal%20Aortic%20Aneurysm.pdf. Zugegriffen: 28.03.2018

  42. Hinchliffe RJ, Ribbons T, Ulug P et al (2013) Transfer of patients with ruptured abdominal aortic aneurysm from general hospitals to specialist vascular centres: results of a Delphi consensus study. Emerg Med J 30:483–486

    Article  PubMed  Google Scholar 

  43. Rubenstein C, Bietz G, Davenport DL et al (2015) Abdominal compartment syndrome associated with endovascular and open repair of ruptured abdominal aortic aneurysms. J Vasc Surg 61:648–654

    Article  PubMed  Google Scholar 

  44. Kirkpatrick AW, Roberts DJ, De Waele J et al (2013) Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med 39:1190–1206

    Article  PubMed  PubMed Central  Google Scholar 

  45. Djavani Gidlund K, Wanhainen A, Bjorck M (2011) Intra-abdominal hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 41:742–747

    Article  CAS  PubMed  Google Scholar 

  46. Karkos CD, Menexes GC, Patelis N et al (2014) A systematic review and meta-analysis of abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg 59:829–842

    Article  PubMed  Google Scholar 

  47. Mayer D, Rancic Z, Meier C et al (2009) Open abdomen treatment following endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg 50:1–7

    Article  PubMed  Google Scholar 

  48. Bjorck M, Wanhainen A (2014) Management of abdominal compartment syndrome and the open abdomen. Eur J Vasc Endovasc Surg 47:279–287

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Universitätsklinik für Anästhesiologie und Schmerztherapie, Universitätsspital Bern, Freiburgstraße, 3010, Bern, Schweiz

    J. Knapp DESA, EDIC, MHBA

  2. Klinik für Anästhesiologie und operative Intensivmedizin, Katharinenhospital, Klinikum Stuttgart, Kriegsbergstraße 60, 70172, Stuttgart, Deutschland

    A. Walther

Authors
  1. J. Knapp DESA, EDIC, MHBA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Walther
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Knapp DESA, EDIC, MHBA.

Ethics declarations

Interessenkonflikt

J. Knapp und A. Walther geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Knapp, J., Walther, A. Anästhesiologisches Management des abdominellen Aortenaneurysmas. Gefässchirurgie 23, 136–144 (2018). https://doi.org/10.1007/s00772-018-0375-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00772-018-0375-y

Schlüsselwörter

Keywords

Search

Navigation