Ultra-fast-track anesthesia management for surgeries for acute type A aortic dissection
10.3760/cma.j.cn131073.20240108.00509
- VernacularTitle:急性A型主动脉夹层手术的超快通道麻醉管理
- Author:
Yifan ZOU
1
;
Qiyuan LIU
;
Xu SUN
;
Yi ZHOU
;
Yun REN
;
Hao YAO
Author Information
1. 南京医科大学第二附属医院麻醉科，南京 210028
- Keywords:
Aneurysm, dissecting;
Aorta;
Ultrafast track anesthetic management
- From:
Chinese Journal of Anesthesiology
2024;44(5):574-578
- CountryChina
- Language:Chinese
-
Abstract:
The clinical data from 16 patients who underwent surgery for acute type A aortic dissection under ultra-fast-track anesthesia (UFTA) in the Second Affiliated Hospital of Nanjing Medical University from August 2023 to December 2023 were collected, and the experience of anesthesia management was analyzed and summarized. UFTA strategy was to reduce inflammation and perform multi-organ protection in the perioperative period through cardiopulmonary bypass methods, medications, etc. According to the process of operation, the long-term and short-acting anesthetic drugs were accurately used to achieve the patient′s awakening immediately after the operation. Deep anesthesia extubation, remifentanil infusion techniques, and nasal high-flow ventilation were used to enable patients to be removed from the endotracheal tube with low stress under the premise of safety. All the patients successfully completed anesthesia induction and anesthesia maintenance. The average surgery duration was (413±92) min, the average anesthesia duration was (480±100) min, the cardiopulmonary bypass time was (168±42) min, the cardiac arrest time was (119±36) min, and the deep hypothermic circulatory arrest lasted (24±5) min. Of these patients, 14 underwent deep hypothermic circulatory arrest combined with unilateral cerebral perfusion via the right axillary artery, and 2 underwent deep hypothermic circulatory arrest combined with retrograde cerebral perfusion via the superior vena cava. All the patients had their tracheal tubes removed within 30 min postoperatively, with blood gas analysis and hemodynamics being within or close to normal ranges. The average postoperative intensive care unit stay time was 6 (3, 11) days, and the total length of hospital stay was (23±8) days. The total hospitalization time extended 20 days in 7 patients due to postoperative complications. All the patients recovered and were discharged. In conclusion, the application of UFTA strategy is safe and feasible in the patients with acute type A aortic dissection, allowing for immediate extubation in the operating room.
