Awake aortic aneurysm repair in patients with severe pulmonary disease

• Published in: The American journal of surgery 1999-08, Vol.178 (2), p.121-124
• Main Authors: McGregor, Walter E, Koler, Amy J, Labat, Gaston Cornu, Perni, Veeraiah, Hirko, Mark K, Rubin, Jeffrey R
• Format: Article
• Language: English
• Subjects: Abdomen; Administration, Inhalation; Aged; Albuterol - administration & dosage; Albuterol - therapeutic use; Anesthesia; Anesthesia, Epidural; Anesthesia, General; Anesthesia, Intravenous; Aorta; Aortic Aneurysm, Abdominal - surgery; Aortic aneurysms; Biological and medical sciences; Blood; Blood Loss, Surgical; Bronchodilator Agents - administration & dosage; Bronchodilator Agents - therapeutic use; Cardiovascular disease; Catheters; Consciousness; Coronary vessels; Critical Care; Dissection; Epidural; Fentanyl; Forced Expiratory Volume - physiology; General anesthesia; Home Care Services; Hospitalization; Hospitals; Humans; Hypnotics and Sedatives - administration & dosage; Iliac Aneurysm - surgery; Inhalation; Intensive care; Intubation; Length of Stay; Lung diseases; Lung Diseases - complications; Lung Diseases - drug therapy; Lung Diseases - therapy; Medical sciences; Morbidity; Mortality; Oxygen Inhalation Therapy; Patients; Pulmonary arteries; Pulmonary functions; Regional anesthesia; Respiration; Respiratory function; Retroperitoneal Space; Retrospective Studies; Risk Factors; Safety; Steroid hormones; Steroids - administration & dosage; Steroids - therapeutic use; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Theophylline; Theophylline - administration & dosage; Theophylline - therapeutic use; Time Factors; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vital Capacity - physiology
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(99)00153-1

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 PO 2 = 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.