scholarly journals Anesthetic management of a surgical patient with an acute aortic dissection complicated by hemoglobin Kansas

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Takashi Kobayashi ◽  
Kenji Suzuki
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Anesthetic Management ◽  
Arterial Oxygen Saturation ◽  
Detailed Examination ◽  
Arterial Oxygen ◽  
Surgical Patient ◽  
Peripheral Tissues ◽  
Aortic Replacement ◽  
Bladder Temperature

Abstract Background Hemoglobin Kansas (Hb Kansas) is a rare disease with cyanosis. We report a case of anesthetic management for a patient with an acute aortic dissection complicated by Hb Kansas. Case presentation We encountered a 62-year-old male, surgical patient with an acute aortic dissection complicated by postoperative Hb Kansas. During anesthesia, his arterial oxygen saturation was low, while the partial pressure of arterial oxygen was within the normal range. The patient underwent ascending aortic replacement under hypothermic circulation arrest with a bladder temperature of 22 °C after introducing cardiopulmonary bypass. The patient was then referred to the hematology department for detailed examination and was diagnosed as having Hb Kansas through genetic analysis at 2 months after surgery. Conclusions Except for apparent cyanosis, Hb Kansas causes no clinical problems because the delivery of oxygen to peripheral tissues may be enhanced for such patients. When we perform anesthetic management for cyanosis patients with unknown causes, it is necessary to consider the oxygen supply-demand balance.

scholarly journals BIOCHEMICAL STUDIES ON SHOCK

1944 ◽  
Vol 79 (1) ◽  
pp. 9-22 ◽  
Author(s):  
Frank L. Engel ◽  
Helen C. Harrison ◽  
C. N. H. Long
Keyword(s):  
Blood Pressure ◽  
Amino Acids ◽  
Oxygen Saturation ◽  
Hepatic Artery ◽  
Arterial Oxygen Saturation ◽  
Amino Nitrogen ◽  
Arterial Oxygen ◽  
High Positive Correlation ◽  
Peripheral Tissues ◽  
Arterial Blood

1. In a series of rats subjected to hemorrhage and shock a high negative correlation was found between the portal and peripheral venous oxygen saturations and the arterial blood pressure on the one hand, and the blood amino nitrogen levels on the other, and a high positive correlation between the portal and the peripheral oxygen saturations and between each of these and the blood pressure. 2. In five cats subjected to hemorrhage and shock the rise in plasma amino nitrogen and the fall in peripheral and portal venous oxygen saturations were confirmed. Further it was shown that the hepatic vein oxygen saturation falls early in shock while the arterial oxygen saturation showed no alteration except terminally, when it may fall also. 3. Ligation of the hepatic artery in rats did not affect the liver's ability to deaminate amino acids. Hemorrhage in a series of hepatic artery ligated rats did not produce any greater rise in the blood amino nitrogen than a similar hemorrhage in normal rats. The hepatic artery probably cannot compensate to any degree for the decrease in portal blood flow in shock. 4. An operation was devised whereby the viscera and portal circulation of the rat were eliminated and the liver maintained only on its arterial circulation. The ability of such a liver to metabolize amino acids was found to be less than either the normal or the hepatic artery ligated liver and to have very little reserve. 5. On complete occlusion of the circulation to the rat liver this organ was found to resist anoxia up to 45 minutes. With further anoxia irreversible damage to this organ's ability to handle amino acids occurred. 6. It is concluded that the blood amino nitrogen rise during shock results from an increased breakdown of protein in the peripheral tissues, the products of which accumulate either because they do not circulate through the liver at a sufficiently rapid rate or because with continued anoxia intrinsic damage may occur to the hepatic parenchyma so that it cannot dispose of amino acids.

Bentall–de Bono procedure for acute aortic dissection

2021 ◽  
Keyword(s):  
Aortic Dissection ◽  
Aortic Root ◽  
Acute Aortic Dissection ◽  
Aortic Surgery ◽  
Acute Type ◽  
Aortic Diseases ◽  
Type A Aortic Dissection ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
Valve Sparing

We present a patient with an acute type A aortic dissection that involves the aortic root. The high mortality of patients with this condition is often associated with operations performed by surgeons with minimal experience dealing with aortic diseases. Therefore, less-experienced surgeons often opt for less complicated techniques like supracoronary ascending aortic replacement. However, according to the latest guidelines for the management of aortic diseases, the aortic root should be replaced when it is compromised by the dissection. The Bentall–de Bono technique treats the aortic root and demands less experience than valve-sparing aortic surgery.

scholarly journals Is limited aortic resection more justified in elderly patients with type A acute aortic dissection?

2020 ◽  
Author(s):  
Wei Qin ◽  
Cunhua Su ◽  
Liangpeng Li ◽  
Michael Carmichael ◽  
Fuahua Huang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Elderly Patients ◽  
Acute Aortic Dissection ◽  
Group Versus ◽  
Type A ◽  
Surgical Approaches ◽  
Elephant Trunk ◽  
Aortic Repair ◽  
Aortic Replacement ◽  
Significant Difference

Abstract Objective This study compared limited aortic repair (ascending, and /or hemi-arch replacement) versus extended-arch repair (ascending, arch and proximal descending aortic replacement) used for patients aged 65 or older, who had type A acute aortic dissection (AAD), analyzing the influence of the extent of aortic repair on outcomes. Methods From January, 2001 to December, 2015, 103 patients aged 65 or older underwent operation due to type A AAD in Nanjing First Hospital. The cohort was divided into two subgroups according to the surgical approaches, including limited aortic replacement (LAR, n = 41) and total arch replacement + stent elephant trunk implantation (TAR + SET, n = 62). Results There was no significant difference in gender, age, hypertension, diabetes, smoking, PCI history, atrial fibrillation, pericardial effusion, aortic valve insufficiency (≥ moderate), shock situation before operation, and Euro-score II between the two groups except limb malperfusion and tear location. The cross-clamp time, CPB time, intubation time, ICU stay time and hospital time were all significantly less in the LAR group than in the TAR + SET group. A total of 89 patients were discharged home successfully after operation, with a difference of hospital mortality (P = 0.04). The overall survival rates at 5-year follow-up were 82.5 ± 6.0% in LAR group and 75.2 ± 5.6% in TAR + SET group, but with no difference (p = 0.151). The freedom from adverse aortic events at 5-year was 84.3 ± 6.5% in LAR group versus 97.9 ± 2.1% in TAR + SET group, with a statistical difference (p = 0.03). Conclusion These findings support limited aortic resection is acceptable for elderly patients with type A AAD if surgical principles allow.

scholarly journals Anesthetic Management of Total Arch Replacement in a Patient with Acute Aortic Dissection and Hemophilia A

2012 ◽  
Vol 32 (4) ◽  
pp. 548-554
Author(s):  
Satsuki HAMADA ◽  
Asako ISHIKAWA ◽  
Yoshinori TANIGAWA ◽  
Kazukuni ARAKI ◽  
Yoshiro SAKAGUCHI
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Hemophilia A ◽  
Anesthetic Management ◽  
Total Arch Replacement

Type A acute aortic dissection: Immediate and mid-term results of emergency aortic replacement with the aid of gelatin resorcin formalin glue

2004 ◽  
Vol 78 (3) ◽  
pp. 853-857 ◽  
Author(s):  
Mitsumasa Hata ◽  
Motomi Shiono ◽  
Akira Sezai ◽  
Mitsuru Iida ◽  
Nanao Negishi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Aortic Replacement ◽  
Mid Term Results

scholarly journals A Case of Partial Arch and Descending Aortic Replacement for a Ruptured Type B Acute Aortic Dissection

2009 ◽  
Vol 38 (1) ◽  
pp. 64-66
Author(s):  
Ko Shibata ◽  
Haruo Makuuchi ◽  
Toshiya Kobayashi ◽  
Masahide Chikada ◽  
Hirosi Murakami ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Type B ◽  
Aortic Replacement

Simplified Elephant Trunk Graft Technique for Aortic Arch Replacement

2002 ◽  
Vol 10 (4) ◽  
pp. 374-375 ◽  
Author(s):  
Shinji Miyamoto ◽  
Tetsuo Hadama ◽  
Hirofumi Anai ◽  
Hidenori Sako ◽  
Tomoyuki Wada ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Aortic Arch ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Distal Anastomosis ◽  
Elephant Trunk ◽  
Aortic Arch Replacement ◽  
Aortic Replacement

We refined the elephant trunk graft to facilitate and reinforce the distal anastomosis in aortic replacement operations. A cuff is created in a single four-branch graft, which is used for the distal anastomosis; the trunk below the cuff is inserted into the distal aortic stump. This method is feasible for repairing extensive aortic aneurysm with a fragile wall and for treating acute aortic dissection where thromboocclusion of the remaining false lumen is desired.

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