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KMID : 0356019890040010021
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Koean Jounral of Critical Care Medicine
1989 Volume.4 No. 1 p.21 ~ p.24
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Anesthetic Management of Ruptrued Abdominal Aortic Aneurysm
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Abstract
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A 63 year-old man, who had past histry of diabetes, hypertension and known aortic aneurysm, was transferred to orerating room for surgical correction of ruptured abdominal aneurysm.
Properative physical examination showed pale and clamsy skin, abdominal distension, mild dyspnea, low arterial blood pressure, tachycardia, anuria. Mental state was relatively clear. Laboratory tests of blood and chest rentgenogram showed anemia, mild metabolic acidosis and hypertensive heart disease. The patient was prepared by intravenous fluid and blood transtusion with cardiotonic before operation.
In spite of continuous infusion of nitroprusside and nitroglycerine. cardiac arrest was developed after clamping of descending aorta and successesfully recovered by open cardiac massage, epinephrine injection and bicrbonate infusion.
Cardiac arrest was repeated with short interval during clamping of descending aorta and was intractable to ressucitative procedure.
Massive dose of nitroglycerine was infused for reduction of afterload in isometric and isotonic contraction. Cardiac rhythm and arterial blood pressure was restored to the mormal level.
Postoperative course was uneventful.
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