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Anesthesia for abdominal aortic disease

Terms in this set (80)

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Full reversal of neuromuscular blockade (i.e., neostigmine or sugammadex)

With rare exceptions, all tracheas are extubated after neurologic integrity is established.

Neurologic deficits on emergence require immediate discussion with the surgeon about the need for angiography, reoperation, or both. Surgeon is usually in the room.

Emergence and extubation may be associated with marked hypertension and tachycardia.

Aggressive pharmacologic intervention is required.
Tight hemodynamic control during this period is likely to be more demanding than during induction.

Neurologic complications (transient and permanent):
Explained by intraoperative embolization, hypoperfusion during carotid clamping, and postoperative embolization or thrombosis from the endarterectomy site.

most neurologic complications are related to surgical technique.

Thromboembolic (rather than hemodynamic) factors appear to be the major mechanism of perioperative neurologic complications and most occur in the postoperative period.

Complications attributable to carotid artery thrombosis 3.3% high rate of major stroke or death despite immediate operative intervention.
Severe HTN: Patients with poorly controlled preoperative hypertension often have severe hypertension postoperatively. The causes are not well understood, but surgical denervation of the carotid sinus baroreceptors is probably contributory.
Postoperative hypotension: Occurs almost as frequently as hypertension after carotid endarterectomy. Carotid sinus baroreceptor hypersensitivity or reactivation probably plays an important role.