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Anesthesia for aortic surgery requiring deep hypothermia

Albert T Cheung, MD
Section Editor
Jonathan B Mark, MD
Deputy Editor
Nancy A Nussmeier, MD, FAHA


Open surgical repair of portions of the ascending aorta or aortic arch may require temporary interruption of cerebral and systemic blood flow [1]. Deliberate hypothermia is induced with the aid of cardiopulmonary bypass (CPB) to protect the brain and other vital organs from ischemia during this period of elective circulatory arrest. Deep hypothermic circulatory arrest (DHCA) permits surgical reconstruction of the aortic arch without crossclamping a diseased aorta or instrumenting and possibly injuring aortic arch branch vessels. Selective antegrade cerebral perfusion (SACP) is a technique to perfuse the brain using the CPB circuit by direct cannulation of the axillary artery or aortic arch branch vessels. Retrograde cerebral perfusion (RCP) is a technique to improve the safety of DHCA by providing partial perfusion to the brain using the cardiopulmonary bypass circuit during interruption of antegrade cerebral perfusion.

This topic discusses anesthetic management and strategies for cerebral protection during cardiac surgical procedures requiring CPB with a period of DHCA, RCP, or SACP. Management of routine CPB and weaning from CPB are discussed separately. (See "Cardiopulmonary bypass: Management" and "Weaning from cardiopulmonary bypass".)

Surgical indications and techniques to accomplish repairs of the ascending aorta and aortic arch are reviewed in other topics. (See "Overview of open surgical repair of the thoracic aorta", section on 'Ascending aorta' and "Overview of open surgical repair of the thoracic aorta", section on 'Aortic arch'.)


The preanesthetic consultation for patients undergoing cardiac surgical procedures is discussed separately. (See "Preanesthetic consultation for cardiac surgery in adults".)

If emergency surgical repair of acute ascending aortic dissection (Stanford type A) is necessary, surgical and preanesthetic evaluation and preparation are expedited so that induction of general anesthesia can proceed without delay. Risk of mortality due to complications (eg, acute aortic regurgitation, cardiac tamponade, stroke, myocardial infarction) is estimated to be as high as 1 to 2 percent per hour after symptom onset (figure 1). (See "Preanesthetic consultation for cardiac surgery in adults", section on 'Emergency surgery' and "Management of acute aortic dissection", section on 'Ascending (type A) aortic dissection'.)

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Literature review current through: Nov 2017. | This topic last updated: Nov 16, 2017.
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