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Chapter 15 - Vascular Anesthesia

Published online by Cambridge University Press:  24 May 2023

By
Jeffrey Park
Edited by
Alan David Kaye  and
Richard D. Urman
Alan David Kaye
Affiliation:
Louisiana State University School of Medicine
Richard D. Urman
Affiliation:
Brigham and Women’s Hospital, Boston
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Summary

Anesthetic management of vascular surgery is highly demanding, due to physiologic perturbations caused by major vascular procedures, as well as the high burden of existing atherosclerotic disease or disease equivalents that are often poorly controlled in this patient population. The perioperative care of the vascular patient is often complex, requiring a thorough preoperative evaluation, sophisticated intraoperative management, and attentive postoperative care. Of paramount importance to the anesthesiologist is the likelihood of major adverse cardiac events (MACEs), the incidence of which may be mitigated by appropriate risk stratification and a detailed understanding of specific major vascular surgical procedures.

Type
Chapter
Information
Cambridge Handbook of Anesthesiology , pp. 234 - 245
Publisher: Cambridge University Press
Print publication year: 2023

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References

Smilowitz, NR, Gupta, N, et al. Trends in perioperative major adverse cardiovascular and cerebrovascular events associated with non-cardiac surgery. JAMA Cardiol. 2017;2(2):181–7.CrossRefGoogle Scholar
Fleisher, L, Fleischmann, K, et al. 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 guideline. Circulation. 2014;130(24):e278–333.Google Scholar
Chou, J, Gylys, M, et al. Preexisting right ventricular dysfunction is associated with higher postoperative cardiac complications and longer hospital stay in high-risk patients undergoing nonemergent major vascular surgery. J Cardiothorac Vasc Anesth. 2019;33(5):1279–86.CrossRefGoogle ScholarPubMed
Meersch, M, Schmidt, S, et al. Perioperative acute kidney injury: an under-recognized problem. Anesth Analg. 2017;125(4):1223–32.CrossRefGoogle ScholarPubMed
Ji, F, Li, Z, et al. Post-bypass dexmedetomidine use and postoperative acute kidney injury in patients undergoing cardiac surgery with cardiopulmonary bypass. PLoS One. 2013;8(10):e77446.CrossRefGoogle ScholarPubMed
Nadim, MK, Forni, LG, et al. Cardiac and vascular surgery-associated acute kidney injury: the 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group. J Am Heart Assoc. 2018;7(11):e08834.CrossRefGoogle ScholarPubMed
Howell, SJ. Carotid endarterectomy. Br J Anaesth. 2007;99(1):119–31.Google Scholar
Ferguson, GG, Eliasziw, M, et al. The North American Symptomatic Carotid Endarterectomy Trial: surgical results in 1415 patients. Stroke. 1999;30(9):1751–8.Google Scholar
Brott, TG, Hobson, RW, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010;363:11–23.Google Scholar
GALA Trial Collaborative Group. General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicenter, randomised controlled trial. Lancet. 2008;372:2132–42.Google Scholar
Smaka, TJ, Miller, TE, et al. Anesthesia for vascular surgery. In: Barash, PG, Cullen, BF, et al., eds. Clinical Anesthesia, 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013, pp. 1128–39.Google Scholar
US Preventive Services Task Force. Screening for abdominal aortic aneurysm: US Preventive Services Task Force Recommendation Statement. JAMA. 2019;322(22):2211–18.Google Scholar
The UK EVAR Trial Investigators.Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med. 2010;362:1868–71.Google Scholar
De Bruin, JL, Baas, AF, et al. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med. 2010;362:1881–9.CrossRefGoogle ScholarPubMed
Lederle, FA, Kyriakides, TC, et al. Open versus endovascular repair of abdominal aortic aneurysm. N Engl J Med. 2019;380:2126–35.Google Scholar
Baril, DT, Kahn, RA, et al. Endovascular abdominal aortic aneurysm repair: emerging developments and anesthetic considerations. J Cardiothorac Vasc Anesth. 2007;21(5):730–42.CrossRefGoogle ScholarPubMed
Spanos, K, Kolbel, T, et al. Risk of spinal cord ischemia after fenestrated or branched endovascular repair of complex aortic aneurysms. J Vasc Surg. 2019;69(2):357–66.Google Scholar
Valentine, RJ, Duke, ML, et al. Effectiveness of pulmonary artery catheters in aortic surgery: a randomized trial. J Vasc Surg. 1998;27(2):203–12.CrossRefGoogle ScholarPubMed
Estrera, AL, Sheinbaum, R, et al. Cerebral fluid drainage during thoracic aortic repair: safety and current management. Ann Thorac Surg. 2009;88:9–15.CrossRefGoogle Scholar
Gelman, S. The pathophysiology of aortic cross-clamping and unclamping. Anesthesiology. 1995;82:1026–57.CrossRefGoogle ScholarPubMed
Bardia, A, Sood, A, et al. Combined epidural-general anesthesia vs general anesthesia alone for elective abdominal aortic aneurysm repair. JAMA Surg. 2016;151(12):1116–23.CrossRefGoogle ScholarPubMed
Levin, SR, Farber, A, et al. Association of anesthesia type with outcomes after outpatient brachiocephalic arteriovenous fistula creation. Ann Vasc Surg. 2020;68:67–75.Google Scholar
Marsh, C, Holloway, J, et al. Outcomes of local and regional anesthesia for superficialization of brachiobasilic arteriovenous fistulas. Ann Vasc Surg. 2020;65:40–4.Google Scholar
Farber, A, Eberhardt, T. The current state of critical limb ischemia: a systematic review. JAMA Surg. 2016;151(11):1070–7.Google Scholar
Adam, DJ, Beard, JD, et al.; BASIL trial participants. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005;366:1925–34.Google ScholarPubMed
Sgroi, MD, McFarland, G. Utilization of regional versus general anesthesia and its impact on lower extremity bypass outcomes. J Vasc Surg. 2019;69(6):1874–9.Google Scholar
Madabhushi, L, Reuben, SS, et al. The efficacy of postoperative perineural infusion of bupivacaine and clonidine after lower extremity amputation in preventing phantom limb and stump pain. J Clin Anesth. 2007;19(3):226–9.CrossRefGoogle ScholarPubMed
Ayling, OGS, Montbriand, J, et al. Continuous regional anaesthesia provides effective pain management and reduces opioid requirement following major lower limb amputation. Eur J Vasc Endovasc Surg. 2014;48(5):559–64.CrossRefGoogle ScholarPubMed

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