- Same Day AdmitPatient (most common): admitted through ASU
- Inpatient: brought to Holding Room.
- Preop workup similar to that for open AAA.
- All patients should have a Type & Screen.
- Two large bore IV's for access (second line accessed post induction).
- Bicarb drip (to reduce incidence of contrast-nephropathy) would usually be started in preop and ordered by surgeon.
- Usual regimen
- 3cc/kg/hr for 1st hour prior to administration of contrast
- after the first hour decrease to 1cc/kg/hr for 6 hours
- Mixed in D5, so follow Blood Glucose.
- If Thoracic Stent planned, ask Surgeon about need for spinal drain catheter
- GA vs Regional
- Either is fine however, there will be times when the surgeon asks to have respirations halted thus if the patient is having a regional anesthetic they need to be awake enough to follow directions and be able to hold their breath.
- LMA's may be less than ideal if halted respirations are required. Patient will be anticoagulated.
- Heat Loss:
- High potential for
- Prewarm room, table, fluids
- Fluid Warmer
- Bair Hugger
- Arterial Line:
- after induction unless indicated prior
- Right arm preferred, in case Left brachial artery needed for angiography
- Central Line: usually not routine
- Vasoactive Drugs:
- Phenylephrine should be set up in line and ready for use
- Inotropes should be in the room – Dopamine or Epinephrine
- Foley: to follow U/O, keep bladder decompressed.
- Fluid Management:
- Typically the patient will receive 2-3 liters of crystalloid in an effort to flush out the average 100 cc of IV contrast unless there is an indication to avoid fluid overload (ie. CHF, ESRD, etc).
- EBL is usually <300 cc.
- There is potential for rapid blood loss, but this is unusual. Emergency Aortic Occlusion Balloon (supra-renal) buys time until conversion to open procedure.
- Duration: Case typically lasts 2-3 hours.
Thoracic Stent:If a doing a thoracic stent graft, it is important to drop the BP during proximal deployment therefore clear communication with surgeon is very important.
Adenosine:Have ready in the room. Occasionally, surgeon may ask for adenosine to temporarily pause everything during thoracic device deployment.
Pain usually managed readily with fentanyl 2-4 mcg/kg intraop.
Patients typically recover in PACU then go to Short Stay.