Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942008000500010
Brazilian Journal of Anesthesiology
Review Article

Anestesia para intervenção cirúrgica endovascular na aorta abdominal

Anesthesia for endovascular surgery of the abdominal aorta

Michelle Nacur Lorentz; Carlos Leonardo Alves Boni; Raquel Reis Soares

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Resumo

JUSTIFICATIVA E OBJETIVOS: O procedimento endovascular para correção de aneurisma de aorta é menos invasivo que o convencional, além de apresentar outras vantagens, como ausência de incisão abdominal, ausência de pinçamento da aorta e menor tempo de recuperação pós-operatória. Por se tratar de procedimento cirúrgico relativamente novo e apresentar uma série de alterações que devem ser conhecidas pelo anestesiologista foi realizado este trabalho com o objetivo de revisar os aspectos mais relevantes do procedimento endovascular e possibilitar manuseio anestésico mais adequado no perioperatório. CONTEÚDO: Apresentação sucinta da técnica cirúrgica para reparo de aneurismas via endovascular, as possíveis vantagens e desvantagens do procedimento, bem como as complicações potenciais. Além disso, foram abordados os cuidados perioperatórios que o procedimento exige e as técnicas anestésicas que podem ser utilizadas. CONCLUSÕES: O conhecimento das alterações provenientes do procedimento endovascular possibilita conduta anestésica mais adequada e melhora dos resultados perioperatórios nesses pacientes.

Palavras-chave

CIRURGIA, Vascular, DOENÇA, Vascular

Abstract

BACKGROUND AND OBJECTIVES: Endovascular surgery for aneurism of the aorta is less invasive than the conventional procedure besides other advantages such as the absence of abdominal incision, absence of ligature of the aorta, and reduced postoperative recovery time. Since it is a relatively new procedure and to presenting a series of changes that should be known by the anesthesiologist, the objective of this report was to review the most relevant aspects of endovascular surgery, allowing more adequate perioperative anesthetic management. CONTENTS: A brief description of the technique of endovascular aneurism repair, possible vantages and disadvantages of its use, as well as potential complications are discussed. CONCLUSIONS: Knowledge of the changes secondary to the endovascular procedure allows a more adequate anesthetic conduct and improves the postoperative results in those patients.

Keywords

DISEASE, Vascular, SURGERY, Vascular

References

Singh K, Bonaa KH, Jacobsen BK. Prevalence and risk factors for abdominal aortic aneurysms in a population-based study. Am J Epidemiol. 2001;154:236-244.

Norris EJ. Perioperative management of the patient undergoing aortic vascular surgery. ASA Refresher. 2005;33:187-202.

Gillum RF. Epidemiology of aortic aneurysm in the United States. J Clin Epidemiol. 1995;48:1289-1298.

Lawrence PF, Gazak C, Bhirangi L. The epidemiology of surgically repaired aneurysms in the United States. J Vasc Surg. 1999;30:632-640.

Delis KT, Gloviczki P, Bjarnason H. Endovascular repair of ruptured saccular aneurysms of the descending thoracic aorta. J Vasc Intervent Radiol. 2006;17:1527-1533.

Dietrich EB. Endovascular surgery and pathology of thoracic aortic. Am Heart Hosp J. 2004;2:89-92.

Eide TO, RomundstanL P, Saether OD. A strategy for treatment of type III and IV thoracoabdominal aortic aneurysm. Ann Vasc Surg. 2004;18:408-413.

Tyer VS, Mackenzie KS, Tse LW. Early outcomes after elective and emergenct endovascular repair of the thoracic aorta. J Vasc Surg. 2006;43:677-683.

Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991;5:491-9.

Rutherford RB, Krupski WC. Current status of open versus endovascular stent-graft repair of abdominal aortic aneurysm. J Vasc Surg. 2004;39:1129-1139.

Nataraj V, Mortimer AJ. Endovascular abdominal aortic aneurysm repair. Continuing Educ Anesth, Crit Care Pain. 2004;4:91-94.

Reilly LM. Endovascular repair of abdominal aortic aneurysm reduces perioperative morbity and mortality. J Cardiothorac Vasc Anesth. 2003;17:655-658.

Lederle FA, Wilson SE, Johnson GR. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med. 2002;346:1437-1444.

Powell JT, Greenhalgh RM. Small abdominal aortic aneurysms. N Engl J Med. 2003;348:1895-1901.

Blankensteijn JD, de Jong SECA, Prinssen M. Two years outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2005;9:2398-2405.

Shames ML, Thompson RW. Abdominal aortic aneurysms: Surgical treatment. Cardiol Clin. 2002;20:563-578.

Santamore DC, Saldanha CL, Santamore WP. Endovascular repair of the abdominal aortic aneurysm. Sem Cardiothorac Vasc Anesth. 2003;7:213-222.

Kuchta KF. Endovascular abdominal aortic aneurysm repair. Sem Cardiothorac Vasc Anesth. 2003;7:205-211.

Clai DJ, Gray B, O'Hara PJ. An evaluation of the costs to health care institutions of endovascular aortic aneurysm repair. J Vasc Surg. 2000;32:148-152.

Berned EO, Scmid EER, Lanchat MT. Nitroglycerin to control blood pressure during endovascular stent-grafting of descending thoracic aortic aneurysms. J Vasc Surg. 2003;31:790-793.

Tanito Y, Masaiuki E. ATP-induced ventricular assystole and hypotension during endovascular D stenting surgery. Can J Anaesth. 1998;45:491-494.

Plaschke K, Boeckler D, Schumacher H. Adenosine-induced cardiac arrest and EEG changes in patients with thoracic aorta endovascular repair. Br J Anaesth. 2006;96:310-316.

Frank SM, Fleisher LA, Breslow MJ. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: A randomized clinical trial. JAMA. 1997;277:1127-1134.

Verhoeven EL, Cina C S, Tielliu IF. Local anesthesia for endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2005;42:402-409.

Hernetta JP, Hodgson KJ, Mattos MA. Feasibility of endovascular repair of abdominal aortic aneurysms with local anesthesia.with intravenous sedation. J Vasc Surg. 1999;29:793-798.

Park WY, Thompson JS, Lee KK. Effect of epidural anesthesia and analgesia on perioperative outcome: A randomized, controlled Veterans Affairs cooperative study. Ann Surg. 2001;234:560-571.

Davies MJ, Silbert BS, Mooney PJ. Combined epidural and general anaesthesia versus general anaesthesia for abdominal aortic surgery: A prospective randomised trial. Anaesth Intensive Care. 1993;21:790-794.

Birkmeyer JD, Stukel TA, Siewers AE. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349:2117-2127.

Mortality results for randomized controlled trial of early elective surgery or ultrassonographic surveillance for small abdominal aneurysms. Lancet. 1998;352:1649-1655.

Garnett RL, MacIntyre A, Lindsay P. Perioperative ischaemia in aortic surgery: combined epidural/general anaesthesia and epidural analgesia vs general anaesthesia and IV analgesia. Can J Anaesth. 1996;43:769-777.

Urban MK, Markowitz SM, Gordon MA. Posoperative prophylatic administration of beta-adrenergic blockers in patient at risk for myocardial ischemia. Anesth Analg. 2000;90:1257-1261.

Raby KE, Brull SJ, Timimi F. The effect of heart rate control on myocardial ischemia among high-risk patients after vascular surgery. Anesth Analg. 1999;88:477-482.

Feringa HH, Bax JJ, Boersma E. High dose beta-blockers and tight heart rate control reduce myocardial ischemia and troponina T release in vascular surgery patients. Circulation. 2006;114:344-349.

Yang H, Raymer K, Butler R. The effects of perioperative beta blockade: results of the Metoprolol after vascular surgery. Am Heart J. 2006;152:983-990.

Mangano DT, Layug EL, Wallace A. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery: Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med. 1996;335:1713-1720.

Feringa HH, Bax JJ, Poldermans D. Perioperative medical management of ischemic heart disease in patients undergoing noncardiac surgery. Curr Opin Anaesthesiol. 2007;20:254-260.

Kertai MD, Boersma E, Westerhout CM. Association between long-term statin use and mortality after successful abdominal aortic aneurysm surgery. Am J Med. 2004;116:96-103.

Mangano DT, Goldman L. Preoperative assessment of patients with known or suspected coronary disease. N Engl J Med. 1995;333:17501756.

Torela F, de Cossart L, Dimitri SK. Routine beta-blockade in vascular surgery. Cardiovasc Surg. 2003;11:459-463.

Devereaux PJ, Beatti WS, Choi PT. How strong is the evidence for the use of perioperative beta blockers in non-cardiac surgery?: Systematic review and meta-analysis of randomised controlled trials. BMJ. 2005;331:313321.

Lindenauer PK, Pekow P, Wang K. Perioperative beta-blocker therapy and mortality after major noncardiac surgery. N Engl J Med. 2005;353:349361.

London MG, Zaugg M, Schaub MC. Peri-operative beta-adrenergic recdeptor blockade: Physiologic foundations and clinical controversies. Anesthesiology. 2004;100:170175.

Fleisher LA, Eagle KA. Clinical practice: Lowering cardiac risk in noncardiac surgery. N Engl J Med. 2001;345:1677-1682.

Licker M, Khatchatourian G, Schweizer A. The impact of a cardioprotective protocol on the incidence of cardiac complications after aortic abdominal surgery. Anesth Analg. 2002;95:1525-1533.

Boersma E, Poldermans D, Bax JJ. Predictors of cardiac events after major vascular surgery: Role of clinical characteristics, dobutamine echocardiography, and beta-blocker therapy. JAMA. 2001;285:1865-1873.

Ligush J, Pearce JD, Edwards MS. Analysis of medical risk factors and outcomes in patients undergoing open versus endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2002;36:492-499.

Ghansah JN, Murphy JT. Complications of major aortic and lower extremity vascular surgery. Sem Cardiothorac Vasc Anesth. 2004;8:335-361.

Lee WA, Berceli SA, Huber TS. Morbidity with retroperitoneal procedures during endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2003;38:459-465.

Lecamwasam HS, Hess D, Brown R. Diaphragmatic paralysis after endovascular stent grafting of a thoracoabdominal aortic aneurysm. Anesthesiology. 2005;102:690-692.

Le Manach Y, Perel A, Coriat P. Early and delayed myocardial infarction after abdominal aortic surgery. Anesthesiology. 2005;102:885-891.

Selim M. Perioperative stroke. N Engl J Med. 2007;356:706-713.

Axelrod DA, Stanley JC, Upchurch GR Jr. Risk for stroke after elective noncarotid vascular surgery. J Vasc Surg. 2004;39:67-72.

Starnes BW, Andersen CA, Ronsivalle JA. Totally percutaneous aortic aneurysm repair: Experience and prudence. J Vasc Surg. 2006;43:270-276.

Baril DT, Kahn RA, Ellozy SH. Endovascular abdominal aortic aneurysm repair: emerging developments and anesthetic considerations. J Cardiothorac Vasc Anesth. 2007;21:730-742.

Qaseem A, Snow V, Fitterman N. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: A guideline from the American College of Physicians. Ann Intern Med. 2006;144:575-580.

Smetana GW. Preoperative pulmonary evaluation: Identifying and reducing risks for pulmonary complications. Cleve Clin J Med. 2006;73:S36-S41.

Warner MA, Offord KP, Warner ME. Role of preoperative cessation of smoking and other factors in postoperative pulmonary complications: A blinded prospective study of coronary artery bypass patients. Mayo Clin. 1989;64:609-616.

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