Abstract
Anesthesia for abdominal aortic reconstruction can present some of the most difficult patient management problems likely to be encountered by the anesthesiologist. Although the stresses imposed upon the patient by aortic cross-clamping and unclamping are often well tolerated, the hemodynamic perturbations that result at times can be severe.
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Management of these hemodynamic derangements is further complicated by the fact that a high percentage of patients presenting for abdominal aortic reconstruction also present with a host of coexisting illnesses. Pulmonary disease, diabetes mellitus, renal insufficiency, and cerebrovascular disease may all, at one time or another, contribute to the difficulty in anesthetic management of patients undergoing abdominal aortic reconstruction and lead to perioperative complications; however, the greatest contributor to perioperative morbidity and mortality is concomitant cardiovascular disease.
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Vascular disease encompasses a wide variety of pathologies, including cerebrovascular disease, thoracic aortic disease, abdominal aortic disease, and cardiovascular and peripheral vascular diseases. The focus of this article, however, is on the anesthetic management of patients undergoing abdominal aortic reconstruction, with particular attention to those patients with concomitant coronary artery disease (CAD) and valvular heart disease.