Core Topics in Vascular Anaesthesia

216 Pages·2012·7.97 MB·English

by  Carl Moores

Core Topics in Vascular
Anaesthesia

Core Topics in Vascular
Anaesthesia
Edited by
Carl Moores
ConsultantAnaesthetist,RoyalInfirmaryofEdinburgh
Alastair F. Nimmo
ConsultantAnaesthetist,RoyalInfirmaryofEdinburgh
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Coretopicsinvascularanaesthesia/[editedby]CarlMoores,
AlastairF.Nimmo.
p. ; cm.
Includesbibliographicalreferencesandindex.
ISBN978-1-107-00181-7(Hardback)
I. Moores,Carl. II. Nimmo,AlastairF. [DNLM:1. Anesthesia.
2. VascularSurgicalProcedures. WG170]
617.96–dc23
2011052384
ISBN978-1-107-00181-7Hardback
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Contents
List of contributors vi
Preface vii
1 Arterial disease and itsmanagement 1 12 Anaesthesia for endovascular aortic repair
Rod T.A. Chalmers surgery 119
Maged Argalious
2 Preoperative riskassessment of vascular
surgery patients 10 13 Anaesthesia for emergency abdominal
John Carlisle andMichael Swart aortic surgery 137
AlastairF. Nimmo
3 Co-existing disease invascular surgery
patients 22 14 Anaesthesia for aorto-iliac occlusive disease
John Carlisle and lower limb revascularisation
procedures 146
4 Reducingperioperative cardiac risk 32
AlastairJ. Thomson
Craig Beattieand BruceBiccard
15 Anaesthesia for lower limb amputation
5 Anaesthesia in the vascular surgery
and the management of post-amputation
patient 48 pain 161
Carl Moores
Charles Mortonand John A. Wilson
6 Monitoringinthevascularsurgerypatient 52 16 Anaesthesia for carotid artery disease 170
Suzy O’Neilland Chris P. Snowden
Mark D.Stoneham
7 Intravenous fluid therapy 62 17 Anaesthesia for vascular surgery tothe
MichaelF.M. James and Ivan A. Joubert upper limb 182
8 Haemostasis and thrombosis 71 Carl Moores
Gary A. Morrison and Alastair F.Nimmo 18 Surgery for vascular access in renal
9 Transfusion andblood conservation 92 dialysis 188
AlastairF. Nimmo and Danny McGee Carl Moores
10 Anaesthesia for elective abdominal aortic
aneurysmsurgery 101
RichardTelford
Index 194
11 Anaesthesia for thoracoabdominal aortic The colour plates aresituatedbetween pages 120
aneurysmsurgery 108 and121.
Carl Moores and Alastair F.Nimmo
v
Contributors
Maged Argalious GaryA. Morrison
AssociateProfessorofAnesthesiology,ClevelandClinic Consultant Anaesthetist, Royal Infirmary of
Lerner College of Medicine, Cleveland, OH, USA Edinburgh, Edinburgh, UK
Craig Beattie Charles Morton
Consultant Anaesthetist, Royal Infirmary of Consultant Anaesthetist, Royal Infirmary of
Edinburgh, Edinburgh, UK Edinburgh, Edinburgh, UK
Bruce Biccard Alastair F. Nimmo
Department of Anaesthetics, Nelson R. Mandela Consultant Anaesthetist, Royal Infirmary of
School of Medicine, University of Kwazulu–Natal, Edinburgh, Edinburgh, UK
Republic of South Africa
Suzy O’Neill
John Carlisle Consultant Anaesthetist, Freeman Hospital,
Consultant Anaesthetist, Torbay Hospital, Newcastle upon Tyne, UK
Torquay, UK
Chris P.Snowden
RodT.A. Chalmers Consultant Anaesthetist, Freeman Hospital.
Consultant Vascular Surgeon, Royal Infirmary of Newcastle upon Tyne, UK
Edinburgh, Edinburgh, UK
Mark D.Stoneham
Michael F.M. James Consultant Anaesthetist, Nuffield Department of
Professor of Anaesthesia, University of Cape Town Anaesthesia, Oxford, UK
andGrooteSchuurHospital,WesternCape,Republic
of South Africa Michael Swart
Consultant Anaesthetist, Torbay Hospital,
IvanA. Joubert
Torquay, UK
Head of Clinical Unit (Critical Care, Department
of Anaesthesia),UniversityofCapeTownandGroote Richard Telford
SchuurHospital,WesternCape,RepublicofSouthAfrica Consultant Anaesthetist, Royal Devon and Exeter
Hospital, Exeter, UK
Danny McGee
Specialist Practitioner in Blood Transfusion, Better Alastair J. Thomson
Blood Transfusion, Scottish National Blood Consultant Anaesthetist, Royal Infirmary of
Transfusion Service, Edinburgh, UK Edinburgh, Edinburgh, UK
CarlMoores John A. Wilson
Consultant Anaesthetist, Royal Infirmary of Consultant Anaesthetist, Royal Infirmary of
Edinburgh, Edinburgh, UK Edinburgh, Edinburgh, UK
vi
Preface
Vascular surgery and anaesthesia have undergone riskassessmentgivesacleardescriptionoftheroleof
greatchangesduringthepastdecadesothatthisbook CPET in patients being considered for surgery.
is very different from previous books describing the Advances in intraoperative monitoring that are dis-
anaesthetic and perioperative management of vascu- cussedincludetheuseoftransoesophagealechocardi-
lar surgical patients. Endovascular repair has been ography and minimally invasive cardiac output
widely adopted for the elective repair of abdominal monitoring.
aorticaneurysmsandisincreasinglybeingusedinthe Our understanding of normal haemostasis and
treatment of ruptured aneurysms. Advanced fenes- how it is disturbed during surgery has also advanced
tratedandbranchedstentgraftshavebeenintroduced greatly, while new anticoagulant drugs have been
for the treatment of suprarenal and thoracoabdom- introduced and the risks of blood transfusion have
inalaneurysms,and‘hybrid’repair–thecombination becomemorewidelyappreciated.Thecauses,diagno-
of endovascular and open surgery – now offers sis and treatment of coagulation abnormalities in
another alternative to the treatment of complex vascular surgery patients are described including the
aneurysms. However, all of these procedures are valueofpoint-of-caretestingofhaemostasis.Modern
accompanied by their own risks for the patient and transfusion practice and blood conservation are dis-
challenges for the surgeon and anaesthetist. The cussedasisthecontroversialareaofintravenousfluid
number of elderly patients with comorbidities pre- therapyduring surgery.
senting for vascular surgery and their expectations Muchhas beenpublished inrecentyearsonredu-
of what medical care can provide have increased and cingtheriskofperioperativecardiaccomplicationsand
manypatientscontinuetorequireopensurgery.This onthebenefitsandrisksofdrugtherapyincludingbeta-
bookprovidesextensivecoverageofthecurrentperi- blockers, coronary artery stents and coronary artery
operative management of both endovascular and bypassgraftsbeforevascularsurgery.However,thisalso
open vascular surgical procedures including aneur- remains an area of controversy. The chapter on redu-
ysm surgery, carotid surgery and revascularisation cingperioperativecardiacriskprovidesaclearreviewof
and amputationfor limb ischaemia. theliteratureandrecommendationsforpractice.
Patient assessment before surgery, and monitor- The contributing authors are acknowledged
ing during surgery, have advanced greatly in recent experts in their fields and we would like to thank
years. Cardiopulmonary exercise testing (CPET) has them for the time and effort that they have put into
become widely used, often as part of anaesthetist-led producingcontributionsthatarenotonlyinformative
pre-assessment clinicswhichaim tohelpthesurgeon but also interesting and stimulating. And, finally, we
and patient decide whether the benefits of interven- would like to thank our publishers for their support
tion outweigh the risks. The chapter on preoperative and patience.
vii