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Anaesthetic management of Abdominal aortic aneurysms

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Abhijit Nair
Health & Medicine
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Anesthesia management for Abdominal Aortic Aneurysms Dr. Abhijit Nair Consultant Anesthesiologist, Care Hospital, Hyderabad.
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Causes: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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Pathogenesis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Guidelines & recommendations ,[object Object],[object Object],[object Object],[object Object]
ct: ,[object Object],[object Object],[object Object],[object Object]
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History: ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classification: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Medical management: ,[object Object],[object Object],[object Object],[object Object],[object Object]
Evaluation of aneurysm ,[object Object],[object Object],[object Object]
Pre-op considerations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Other co morbidities: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Drug issues: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Work up: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
LABS ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intra op: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intraop concerns: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cross clamp! ,[object Object],[object Object],[object Object],[object Object],[object Object]
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[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Post op: ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Renal insufficiency: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Renal protection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Myocardial protection: ,[object Object],[object Object],[object Object],[object Object],[object Object]
Ruptured AAA! ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Distribution sites of AAA rupture: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Estimated Annual rupture risk
 
Risk stratification: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hardman Index! Hardman index: 1 point is assigned for each preoperative variable present, so the possible score ranges from 0–5. A total score of 2 is consistent with a mortality rate of 80%. Points 1 Age> 76 1 Creat > 190 umol/L 1 Hb < 9gm% 1 MI on ECG 1 H/o LOC on hospital arrival
Glasgow Aneurysm Score(GAS) Points Age of patient ( point= no. of yrs) 17 Shock 7 Myocardial disease 10 Cerebrovascular disease 14 Renal disease
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Predictors of early mortality ,[object Object],[object Object],[object Object]
Surgical complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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Spinal cord protection: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Most common :- LUMBAR DRAIN!
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Factors causing ACS: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Surgical concerns ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Advantages & disadvantages of EVAR
Anesthetic technique in EVAR: ,[object Object],[object Object],[object Object],[object Object]
Complication of EVAR: ( device related ) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Procedure relate EVAR complications: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Systemic complications of EVAR: ,[object Object],[object Object],[object Object],[object Object],[object Object]
Statistics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(Endovascular vs open repair of AAAs in Medicare population. Schermerhan etal. N Engl J Med 2008; 358: 464-74.)
Conclusion ,[object Object],[object Object],[object Object],[object Object]
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Anaesthetic management of Abdominal aortic aneurysms

  • 1. Anesthesia management for Abdominal Aortic Aneurysms Dr. Abhijit Nair Consultant Anesthesiologist, Care Hospital, Hyderabad.
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  • 58. Hardman Index! Hardman index: 1 point is assigned for each preoperative variable present, so the possible score ranges from 0–5. A total score of 2 is consistent with a mortality rate of 80%. Points 1 Age> 76 1 Creat > 190 umol/L 1 Hb < 9gm% 1 MI on ECG 1 H/o LOC on hospital arrival
  • 59. Glasgow Aneurysm Score(GAS) Points Age of patient ( point= no. of yrs) 17 Shock 7 Myocardial disease 10 Cerebrovascular disease 14 Renal disease
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  • 65. Most common :- LUMBAR DRAIN!
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