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Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 1988 Mar;70(2):64–68.

Anaesthetic problems in cross clamping of the thoracic aorta.

P M Spargo 1, M M Crosse 1
PMCID: PMC2498652  PMID: 3408161

Abstract

Cross clamping of the descending thoracic aorta is performed in this hospital for graft replacement of suprarenal aneurysms or during endarterectomy for extensive aortic occlusive disease. The anaesthetic management of nine patients is described and the surgical results are presented. Proximal aortic clamping and declamping lead to profound haemodynamic changes. Myocardial infarction, ventricular failure and even death may result. Renal preservation during clamping and massive blood transfusion are also problems of this surgical approach. The measures taken to ameliorate the consequences of proximal aortic clamping are discussed in detail.

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Selected References

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  1. Attia R. R., Murphy J. D., Snider M., Lappas D. G., Darling R. C., Lowenstein E. Myocardial ischemia due to infrarenal aortic cross-clamping during aortic surgery in patients with severe coronary artery disease. Circulation. 1976 Jun;53(6):961–965. doi: 10.1161/01.cir.53.6.961. [DOI] [PubMed] [Google Scholar]
  2. Brusoni B., Colombo A., Merlo L., Marchetti G., Longo T. Hemodynamic and metabolic changes induced by temporary clamping of the thoracic aorta. Eur Surg Res. 1978;10(3):206–216. doi: 10.1159/000128009. [DOI] [PubMed] [Google Scholar]
  3. Cameron J. S. Acute renal failure in the intensive care unit today. Intensive Care Med. 1986;12(2):64–70. doi: 10.1007/BF00254514. [DOI] [PubMed] [Google Scholar]
  4. Carroll R. M., Laravuso R. B., Schauble J. F. Left ventricular function during aortic surgery. Arch Surg. 1976 Jul;111(7):740–743. doi: 10.1001/archsurg.1976.01360250016002. [DOI] [PubMed] [Google Scholar]
  5. Cohn J. N., Franciosa J. A. Vasodilator therapy of cardiac failure: (first of two parts). N Engl J Med. 1977 Jul 7;297(1):27–31. doi: 10.1056/NEJM197707072970105. [DOI] [PubMed] [Google Scholar]
  6. Counts R. B., Haisch C., Simon T. L., Maxwell N. G., Heimbach D. M., Carrico C. J. Hemostasis in massively transfused trauma patients. Ann Surg. 1979 Jul;190(1):91–99. doi: 10.1097/00000658-197907000-00020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Crawford E. S., Walker H. S., 3rd, Saleh S. A., Normann N. A. Graft replacement of aneurysm in descending thoracic aorta: results without bypass or shunting. Surgery. 1981 Jan;89(1):73–85. [PubMed] [Google Scholar]
  8. Diehl J. T., Cali R. F., Hertzer N. R., Beven E. G. Complications of abdominal aortic reconstruction. An analysis of perioperative risk factors in 557 patients. Ann Surg. 1983 Jan;197(1):49–56. [PMC free article] [PubMed] [Google Scholar]
  9. Dunn E., Prager R. L., Fry W., Kirsh M. M. The effect of abdominal aortic cross-clamping on myocardial function. J Surg Res. 1977 May;22(5):463–468. doi: 10.1016/0022-4804(77)90028-2. [DOI] [PubMed] [Google Scholar]
  10. Gelman S., Reves J. G., Fowler K., Samuelson P. N., Lell W. A., Smith L. R. Regional blood flow during cross-clamping of the thoracic aorta and infusion of sodium nitroprusside. J Thorac Cardiovasc Surg. 1983 Feb;85(2):287–291. [PubMed] [Google Scholar]
  11. Harker L. A., Slichter S. J. The bleeding time as a screening test for evaluation of platelet function. N Engl J Med. 1972 Jul 27;287(4):155–159. doi: 10.1056/NEJM197207272870401. [DOI] [PubMed] [Google Scholar]
  12. Kouchoukos N. T., Lell W. A., Karp R. B., Samuelson P. N. Hemodynamic effects of aortic clamping and decompression with a temporary shunt for resection of the descending thoracic aorta. Surgery. 1979 Jan;85(1):25–30. [PubMed] [Google Scholar]
  13. Lunn J. K., Dannemiller F. J., Stanley T. H. Cardiovascular responses to clamping of the aorta during epidural and general anesthesia. Anesth Analg. 1979 Sep-Oct;58(5):372–376. doi: 10.1213/00000539-197909000-00005. [DOI] [PubMed] [Google Scholar]
  14. Meloche R., Pottecher T., Audet J., Dufresne O., LePage C. Haemodynamic changes due to clamping of the abdominal aorta. Can Anaesth Soc J. 1977 Jan;24(1):20–34. doi: 10.1007/BF03006809. [DOI] [PubMed] [Google Scholar]
  15. Rao T. L., Jacobs K. H., El-Etr A. A. Reinfarction following anesthesia in patients with myocardial infarction. Anesthesiology. 1983 Dec;59(6):499–505. doi: 10.1097/00000542-198312000-00003. [DOI] [PubMed] [Google Scholar]
  16. Roizen M. F., Beaupre P. N., Alpert R. A., Kremer P., Cahalan M. K., Shiller N., Sohn Y. J., Cronnelly R., Lurz F. W., Ehrenfeld W. K. Monitoring with two-dimensional transesophageal echocardiography. Comparison of myocardial function in patients undergoing supraceliac, suprarenal-infraceliac, or infrarenal aortic occlusion. J Vasc Surg. 1984 Mar;1(2):300–305. [PubMed] [Google Scholar]
  17. Silverstein P. R., Caldera D. L., Cullen D. J., Davison J. K., Darling R. C., Emerson C. W. Avoiding the hemodynamic consequences of aortic cross-clamping and unclamping. Anesthesiology. 1979 May;50(5):462–466. doi: 10.1097/00000542-197905000-00016. [DOI] [PubMed] [Google Scholar]
  18. Spargo P. M., Tait A. R., Knight P. R., Kling T. F. Effect of nitroglycerine-induced hypotension on canine spinal cord blood flow. Br J Anaesth. 1987 May;59(5):640–647. doi: 10.1093/bja/59.5.640. [DOI] [PubMed] [Google Scholar]
  19. Wickham J. E., Fernando A. R., Hendry W. F., Watkinson L. E., Whitfield H. N., Armstrong D. M., Griffiths J. R. Inosine in preserving renal function during ischaemic renal surgery. Br Med J. 1978 Jul 15;2(6131):173–174. doi: 10.1136/bmj.2.6131.173. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Zaidan J. R., Guffin A. V., Perdue G., Smith R., McNeill D. C. Hemodynamics of intravenous nitroglycerin during aortic clamping. Arch Surg. 1982 Oct;117(10):1285–1288. doi: 10.1001/archsurg.1982.01380340021006. [DOI] [PubMed] [Google Scholar]

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