Laparoscopic anesthesia of abdominal aortic aneurysm

The article was consulted professionally by Specialist Doctor II Dinh Van Loc – General Surgeon – Share99 Da Nang International Health Hub.

The most dangerous complications of aortic aneurysm are rupture of the vessel at the site of the aneurysm, which leads to death for the person. In addition, the disease also leads to complications such as: Loss of blood, severe breathing, chest pain, hypotension, pale blue skin.

The main cause was found to be related to injuries or unmanied hypertension.

The majority of cases of abdominal aortic aneurysms do not show specific symptoms, which can be detected by chance due to computer or ultrasound scans.

The most prominent symptoms of patients with abdominal aortic aneurysms are: Abdominal pain, feeling like there is a mass beating the same heart rate in the abdomen, or indirect signs because the aneurysm is causing compression to neighboring organs such as the duodenum, ureter.

In particular, some patients will experience signs of rupture or threat of rupture such as: Sudden and severe abdominal pain, accompanied by hypotension.

Pre-surgery evaluation: Pre-surgical optimization should be focused on the treatment of lung diseases simultaneously. Stopping smoking a few days before surgery is more dangerous than constant use . This may be due to an increase in mucus production and cough commonly seen in people who have stopped smoking recently

Coronary anethography or recent issentiography tests with no signs or symptoms of recurrence, or people with small stratified signs of cardiovascular risk with moderate tolerance. If the patient has the main predictive cardiovascular signs with an increased risk of cardiovascular surgery, they should be immediately referred for coronary ancillary scan before surgery. All other patients should be given non-invasive tests.

In-administration anesthesia is anesthesia technique for the whole body and is insularly placed with the aim of controlling the patient's breathing during surgery as well as resuscitation after surgery.

Anesthesia is the first step in laparoscopic surgery of abdominal aortic aneurysm, consisting of the following steps:

Anaesthesia techniques

Repair of an end aneurysm can be carried out using various anesthesia techniques, such as body anesthesia, regional anesthesia and local anesthesia in combination with sedatives . The effects of anesthesia in the procedure have not yet been determined; however, there are times when one technique is more profitable than others.

Body anesthesia is the technique of choice for post-conjunctivitis, respiratory failure, blood clot disorders, use of eal ultrasound, long-term surgery or patient rejection of regional anesthesia.

Several spinal anesthesia techniques have been successfully used in endvascular surgery, and this appears to be the technique of choice for most abdominal aneurysm patients. Prevention of surgical responses to stress, associated with intt management, reduced inflammatory response, not mechanical ventilation in patients with severe lung and heart disease, besides having an analgesic effect after surgery, is one of its main advantages.

The use of sural and sedular anesthesia with and without cathetics, in addition to sural anesthesia in combination with spinal anesthesia has been applied. The continuous use of sural or sural blockade seems to be the technique of choice in most centers. When deciding to use spinal anesthesia, one should be aware of the period of time required between the duration of the effect and the time of heparin neutralation) to reduce the change of the permancular hematoma.

Local anesthesia combined with anesthetic sedatives is also widely applied.

Regardless of the anaesthetic technique selected, this decision must be based on the duration of the procedure and the experience of the surgical team, it is necessary to discuss it in advance with the surgeon and it is necessary to prepare in advance the possibility of immediate in-administration anesthesia for open surgery .

• Patient's position: The patient lies on his back, is breathing oxygen 100% at a dosage of 3-6 L/min before the onsentation of the coma for at least 5 minutes. Then install the tracking device and set up high-efficiency transmission lines.
• Use mesmerizing money (if necessary).
• Anaesthesia: Use sleeping pills, vaporizing anesthesies such as sevofluran, or intravenous anesthesies such as propofol, etomidat, ketamin,… Analgesgesgesy such as: morphine, fentanyl, sufentanil,… Muscle relaxer: rocuronium, vecuronium, succinylcholin,…
• Intt management: The condition to be able to install a peddular connector for the patient is that the patient has a deep sleep, has enough elasticity of the muscle (there are two techniques for installing a tunnel that is through the nasal and oral lines).

4.1 Oral ina administration

• Open the patient's mouth, use a checkered light on the right side of the mouth, and remove the tongue to the left side, and push the lamp deeper, combined with the right hand of the technician to press the cartilage bordering the patient's ring in search of the cap of the bar, the bar hole.
• Perform a quick oncage of the patient and perform the Sellick procedure for cases where the stomach is full.
• Then quickly insert the intt management tube gently through the patient's rye, stopping only when the shadow of the intt management tube has passed through the sound cords for 2-3 cm.
• Slowly unplrage the checkered lights gently.
• In-in-administration ball pump.
• Check the exact location of the ins tradular tube in the patient's body by listening to the lungs along with etco2 results.
• Fix the innular tube with adhesive tape.
• Place the canul in the mouth of the sick person to avoid biting the tube (if necessary).

4.2 Nasal ine administration

• Choose the side of the patient's nose to ventilate and use small drugs to help shrink the nose (e.g. naphazolin, otrivine …).
• Choosing the size of the ineocular tube must be smaller than the patient's mouth line. Then the in-administration tube was lubricated by lidocain fat through the nostrils.
• Open your mouth and insert the checker into the right side of your mouth, turn your tongue to the left and push the lights deep, working together with your right hand to crush the cartilage bordering the ring, helping to find the bar hole and the bar cap.
• Proceed to the withdrawal of the checkered lamps gently. Quickly pump in-in-administration balloons.
• Re-examine the exact location of the in-administration tube by listening to the lungs with etco2 results.
• Fix the innular tube with adhesive tape.

4.3 Special process application for difficult in-administration pipe

• If there are difficult cases when in-administration is difficult, follow the following steps:
• Maintain anesthesia: Maintain anesthesia with intravenous anesthesies or vaporizing anesthesies, or analgesic, and use additional muscle relaxes (if necessary).
• Control the patient's breathing with a machine or squeeze their hands.

4.4 Patient monitoring

• Basic monitoring includes electrolyses (ECG),
• Measurement of oxygen saturation in capillary blood (SPO 2), capnography( EtCo2),
• and temperature is required,
• Place a cathethe tube to monitor the amount of urine.
• An arterial cathethe tube is necessary both to monitor arterial blood pressure continuously and to get blood tested. Central vein pressure (CVP) is rarely necessary, unless the patient has any related disease to justify its use.
• Cardiac ultrasound through the veins is used in selected cases to better determine the anatomy of the vessels and to guide the positioning of the stent.
• A large intravenous line is very important for the final blood transfusion and rapid infusion.

4.5 Hemolysis control

Hemolytic changes that occur in normal surgery are replaced by endal surgeries. This procedure does not involves laparoscopic surgery, aortic clamping or the loss of a large amount of blood.

The average infusion demand is 1500-2000 mL .

The results of a multiple-center study comparing blood loss between open and invascular surgery demonstrated 60% lower blood loss in endalley (650 mL) than open surgery (1,600 mL), resulting in a decrease in the need for blood transfusions in end-invascular procedures (12% vs. 40%).

On the other hand, the anesthesi should choose the most complete infusion technique, keep in mind that the patient is antisymetic, maintains a good infusion balance during and after surgery to reduce the rate of kidney damage caused by the photothetic used in the process, provides the appropriate conditions for stent placement , and is prepared for surgical conversion.

Antiaxic drugs should be monitored periodically to maintain the ACT for about 250 seconds, which means additional doses of heparin are needed during prolonged procedures. At the end of the surgery, protamine is used to reverse the effects of heparin. Some authors prefer to wait for the normalization of the ACT without protamine to avoid harmful consequences when used.

Stages of hypotension can be achieved by several techniques to maintain an average arterial blood pressure of about 60 mmHg that is necessary during stent placement. Some studies point to the use of nitroglycerin or sodium nitroprusside; alternatively, the dose of volatile anesthetics may be increased or additional doses of local anesthesia can be taken through the cathethetics if the patient is constantly sealed.

Some authors use intravenous esmolol and adenosine to promote bradycardia and tashcardia while placing stents. The goal of this technique is to prevent the distant movement of the stent due to the internal thrust flow in the sysent in artery repair. However, this technique was used when invascular surgery was first implanted, when the stent expansion time was much greater. With the advance of the technique and with new stent models, the stent expansion time and stent movement rate have decreased, reducing the need for sysys and hypotension and, therefore, their consequences. Adenosine is commonly used in the treatment of tachycardia on the anodes because rapid injections cause a decrease in heart rate, and even complete atrial fibrillation(block A-V), short-action drugs, with hemolysis stability for 10 seconds.

4.6 Insto manageable standard for patients

• The patient is awake, can follow the instructions of the medical staff.
• The patient's head can be raised for more than 5 seconds, with TOF > 0.9 (if any).
• Breathe on your own, with breathing frequency within normal limits.
• Stable pulse and blood pressure.
• Body temperature > 35oC.
• No complications of anesthesia, surgery.

Although considered a minimally invasive procedure, a number of complications are associated with the repair of an invascular aneurysm; among them is the rupture of the aneurysm, which can be a disastrous event and should be intervened immediately. Risk factors for this complications include: the stent placement and its size. Hypotension may be the result of improper movement or placement of stents that lead to vascular embolism or the non-complete exclusion of an aortic aneurysm (endoleak), distant aortic embolism with atherosclerosis plaques or thromboemboyeritis, is ishatic. A good vein access must be available for quick replacement and continuous IABP monitoring. Differentive diagnosis of hypotension consists of a sympathetic blockade, in the case of sub-stenosis or an out-of-sural mass, allergy to photohocular drugs and the use of an anthodilologist.

The risk during and after surgery of myocardial infarction as well as stroke cannot be ignored. Strokes are mainly is ismanemia or iseoremia and aortic atherosclerosis is an independent risk factor for this serious complications . It is extremely important to maintain sinus rhythm, since atrial fibrillation is one of the causes of stroke.

Possible spinal anemia and the role of spinal fluid aerated fluid to protect spinal cord perfusence in open surgery, although widely used, remain controversial. Some authors use this technique in endvascular surgery, besides avoiding hypothermia and hypotension.

Post-stent transplant syndrome may develop, which is characterized by fever, increased concentration of C-reticing proteins and leukocyukocysis in the event of no infection. It lasts from two to 10 days and responds to the effects of non-steroidal anti-inflammatory drugs. It is thought that the development of a significant inflammatory reaction is second to endotuloid activation due to the manipulation of the stent that occurs. Sometimes, severe hypokalemia is caused by excessive capillary permeability, decreased return to the veins, respiratory failure due to increased excessive capillary permeability and pervasive intravascular coacillation may develop.

It can be seen that anesthesia of laparoscopic abdominal aortic aneurysm helps to control the pain of the patient during surgery extremely effectively. Accordingly, any errors in this process can also cause dangers to the life of the patient. Therefore, you should choose reputable medical facilities to perform anesthesia, surgery, ensure safety and no complications.

Share99 International Health Hub is one of the hospitals that strictly applies the standards of safe surgical anesthesia practice according to international guidelines. Share99 has a team of experienced anesthesiators and nurses, modern equipment such as: nerve detectors, ultrasound machines, Karl Storz's difficult airway control system, GE's comprehensive AoA (Adequate of Anesthesia) monitoring system including anaesthesia monitoring, pain and muscle dilation will bring high quality and safety , help patients with sufficient anesthesia, no awakening, no residue of muscle relaxes after surgery.

Dr. Dinh Van Loc graduated as a General Doctor in Hue in 1990, graduated from Specialist I in 2003 and Specialist II Anesthesithesiist in 2017. Dr. Loc is highly trained in advanced anesthesia and has more than 23 years of experience in pediatric intensive resuscitation anesthesia, cranial neuropsychihetism, anesthesia for hepatic rehabilitation surgery, mental removal at the Health Hub.

To register for examination and treatment at Share99 International Health Hub, you can contact Share99 Health System nationwide, or register for an online examination HERE.

SEE:

• How dangerous is aortic aneurysm and how is it treated?
• Chest aortic aneurysm warning signs
• Aortic aneurysm: In what cases does the stent graft be placed?