Awake aortic aneurysm repair in patients with severe pulmonary disease

McGregor, Walter; Koler, Amy J; Labat, Gaston Cornu; Perni, V.C.; Hirko, Mark K.; Rubin, Jeffrey R.

doi:10.1016/s0002-9610(99)00153-1

Cited by 18 publications

(12 citation statements)

References 11 publications

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“…Theoretically, these adverse effects could be avoided by using TEA in an awake patient. Successful awake major surgery under TEA including aortic aneurysm repair [12], and coronary artery bypass grafting [13] has been recently reported. Furthermore, TEA has been anecdotally employed for thoracoscopic management of secondary pneumothorax [14].…”

Section: Resultsmentioning

confidence: 99%

Feasibility and Results of Awake Thoracoscopic Resection of Solitary Pulmonary Nodules

Pompeo¹,

Mineo²,

Rogliani³

et al. 2004

The Annals of Thoracic Surgery

220

171

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Background. General anesthesia with single-lung ventilation is considered mandatory for thoracoscopic pulmonary resection. We assessed in a randomized study the feasibility and results of awake thoracoscopic resection of solitary pulmonary nodules.Methods. Between March 2001 and February 2003, 60 patients were randomized into two 30-patients arms: a general anesthesia arm entailing double-lumen intubation and thoracic epidural anesthesia (control group); and an awake arm entailing sole thoracic epidural anesthesia at T4-T5 (awake group). Anesthesia time; operative time; global operating room time; patient satisfaction with the anesthesia and technical feasibility scored into 4 grades (from 1 ‫؍‬ poor to 4 ‫؍‬ excellent); visual analog pain score (VAS), nursing care (number of patient calls per day), 24 hours changes in arterial oxygenation (⌬PaO 2 ), and hospital stay were assessed.Results. There was no mortality. There was no difference

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Section: Resultsmentioning

confidence: 99%

Feasibility and Results of Awake Thoracoscopic Resection of Solitary Pulmonary Nodules

Pompeo¹,

Mineo²,

Rogliani³

et al. 2004

The Annals of Thoracic Surgery

220

171

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“…Successful elective OSR using "mini-laparotomy" or by retroperitoneal exposure has been performed using epidural anesthesia with either low dose inhalation anesthesia or in the awake patient. [371][372][373] These techniques should be considered experimental.…”

Section: Choice Of Anesthetic Technique and Agentmentioning

confidence: 99%

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

Chaikof

Brewster

Dalman

et al. 2009

Journal of Vascular Surgery

625

520

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DEFINITION OF THE PROBLEM Purpose of these guidelinesThe Clinical Practice Council of the Society for Vascular Surgery charged a writing committee with the task of updating practice guidelines, initally published in 2003, for surgeons and physicians who are involved in the preoperative, operative, and postoperative care of patients with abdominal aortic aneurysms (AAA). 1 This document provides recommendations for evaluating the patient, including risk of aneurysm rupture and associated medical co-morbidities, guidelines for selecting surgical or endovascular intervention, intraoperative strategies, perioperative care, long-term follow-up, and treatment of late complications.Decision making related to the care of patients with AAA is complex. Aneurysms present with varying risks of rupture and patient specific factors influence anticipated life expectancy, operative risk, and the need to intervene. Careful attention to the choice of operative strategy, as influenced by anatomic features of the AAA, along with optimal treatment of medical co-morbidities is critical to achieving excellent outcomes. Moreover, appropriate postoperative patient surveillance and timely intervention in the case of a late complication is necessary to minimize subsequent aneurysm-related death or morbidity. All of these clinical decisions are determined in an environment where cost-effectiveness will ultimately dictate the ability to provide optimal care to the largest possible segment of the population. Currently available clinical data sets have been reviewed in formulating these recommendations. However, an important goal of this document is to clearly identify those areas where further clinical research is necessary. Methodology and evidenceA comprehensive review of the available clinical evidence in the literature was conducted in order to generate a concise set of recommendations. The strength of any given recommendation and the quality of evidence was scored based on the GRADE system (Table I). 2 When the benefits of an intervention outweighed its risks, or, alternatively, risks outweighed benefits, a strong recommendation was noted. However, if benefits and risks were less certain, either because of low quality evidence or because high quality evidence suggests benefits and risks are closely balanced, a weak recommendation was recorded. The quality of evidence that formed the basis of these recommendations was scored as high, moderate, or low. Not all randomized controlled trials are alike and limitations may compromise the quality of their evidence. In addition, if there is a large magnitude of effect, the quality of evidence derived from observational studies may be high. Thus, quality of evidence was scored as high when additional research is considered very unlikely to change confidence in the estimate of effect; moderate when further research is likely to have an important impact in the estimate of effect; or low when further research is very likely to change the estimate of the effect.

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“…Awake major surgery under TEA has been recently reported and included aortic aneurysm repair in patients with severe pulmonary disease 14 and coronary artery bypass grafting. 15,16 Furthermore, TEA has been successfully used for thoracoscopic management of secondary pneumothorax 17 and more recently for resection of solitary pulmonary nodules.…”

Section: Discussionmentioning

confidence: 99%

Awake Non-Resectional Lung Volume Reduction Surgery

Pompeo¹,

Onorati²,

Mineo³

2012

Awake Thoracic Surgery

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Objective: To assess the feasibility, safety, and early results of awake lung volume reduction surgery (LVRS) performed under thoracic epidural anesthesia by a new nonresectional technique. Summary Background Data: So far, resectional LVRS under general anesthesia and one-lung ventilation is the more frequently used technique, but procedure-related morbidity has been considerable. Methods: The study cohort included 12 patients undergoing unilateral awake LVRS. Evaluated parameters included technical feasibility and anesthesia satisfaction scored into 4 grades (from 1 ϭ poor to 4 ϭ excellent), global operating room time, and arterial carbon dioxide tension (PaCO 2 ). In addition, 6-month changes in outcome measures, including forced expiratory volume in 1 second (FEV1), residual volume (RV), 6-minute walking test (SMWT), and dyspnea index were recorded. Perioperative and 6-month results were comparable with those of a control group undergoing unilateral resectional LVRS. Results: Technical feasibility was excellent to satisfactory in 11 patients. One patient required conversion to one-lung ventilation. Differences between the awake and control group included global operating room time (90 Ϯ 17 minutes versus 145 Ϯ 19 minutes, P Ͻ 0.00001); PaCO 2 24 hours after surgery (45 Ϯ 6 mm Hg versus 49 Ϯ 6 mm Hg, P ϭ 0.02); and hospital stay (7.8 Ϯ 5 days versus 11.7 Ϯ 4 days, P ϭ 0.02). Significant (P Ͻ 0.002) improvements occurred at 6 months in FEV1 (0.31 Ϯ 0.17 L), RV (Ϫ1.41 Ϯ 0.7 L), SMWT (73 Ϯ 25 m), and dyspnea index (Ϫ1.3 Ϯ 0.5) and were comparable with those of the control group. Conclusions: In this study, awake nonresectional LVRS proved feasible and safe. This new modality was associated with a faster recovery and satisfactory 6-month outcome, which did not differ from that of resectional LVRS. (Ann Surg 2006;243: 131-136)

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Awake aortic aneurysm repair in patients with severe pulmonary disease

Cited by 18 publications

References 11 publications

Feasibility and Results of Awake Thoracoscopic Resection of Solitary Pulmonary Nodules

Feasibility and Results of Awake Thoracoscopic Resection of Solitary Pulmonary Nodules

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

Awake Non-Resectional Lung Volume Reduction Surgery

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