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Continuing Education in Anaesthesia, Critical Care & Pain 2008 8(1):11-15; doi:10.1093/bjaceaccp/mkm050
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© The Board of Management and Trustees of the British Journal of Anaesthesia [2008]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Anaesthesia for ruptured abdominal aortic aneurysm

Anton Leonard, FRCA MRCPI
Specialist Registrar/Honorary Lecturer in
Anaesthesia
University Division of Anaesthesia
Critical Care and Pain Management
UHL NHS Trust
Leicester Royal Infirmary
Leicester LE1 5WW, UK

Jonathan Thompson, BSc (Hons) MD, FRCA
Senior Lecturer in Anaesthesia and
Critical Care
Division of Anaesthesia
Critical Care and Pain Management
Department of Cardiovascular Sciences
University of Leicester and UHL NHS
Trust
Leicester Royal Infirmary
Leicester LE1 5WW, UK
Tel: +44 0116 258 5291
Fax: +44 0116 285 4487
E-mail: jt23@le.ac.uk

Key Words: Aortic aneurysms occur because of imbalance between aortic wall matrix metalloproteinases and their inhibitors • Preoperative fluid resuscitation should aim to treat myocardial ischaemia or unconsciousness rather than to normalize circulating volume or arterial pressure. • The Glasgow Aneurysm Score can help stratify perioperative risk and thereby supplement clinical decision making. • Intra-abdominal hypertension is common following ruptured abdominal aortic aneurysm (AAA) repair and intra-abdominal pressure monitoring is recommended. • The inter-hospital transfer of haemodynamically stable patients with a ruptured AAA does not seem to affect outcome adversely.

The first 150 words of the full text of this article appear below.

Ruptured abdominal aortic aneurysm (AAA) is commonly fatal, with an overall mortality rate of 65%.1 The mortality rate for patients who survive to reach hospital and undergo emergency surgery is ~36%, compared with 6% for elective repair.2


   Epidemiology and natural history
 
Abdominal aortic aneurysms (AAAs) occur predominantly in male cigarette smokers aged >65 years and are the 13th most common cause of death in the USA. Chronic cigarette smoking is the single most important risk factor in both the development and progression of AAA. The prevalence of AAAs (aortic diameter > 30 mm) in chronic smokers is more than four times that in lifelong non-smokers, and the average rate of aneurysm growth in smokers is 2.8 mm per year versus 2.5 mm per year in non-smokers. The most common cause of AAA is atherosclerosis; rare causes include Marfan syndrome, salmonella, brucellosis, tuberculosis, and Takayasu's disease.

AAAs are usually asymptomatic but expand over time and . . . [Full Text of this Article]


   Pathophysiology
 

   Medical management
 

   Presentation and diagnosis
 

   Patient selection and risk stratification
 

   Preoperative management
 

   Anaesthetic management
 
Induction

Maintenance

Aortic cross-clamping

Monitoring, blood transfusion, and thermoregulation

Maintenance of renal function


   Postoperative care
 

   Endovascular abdominal aortic aneurysms repair
 

   Inter-hospital transfer
 

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