Organ protection during aortic cross-clamping

Publication date: Available online 20 August 2016 Source:Best Practice & Research Clinical Anaesthesiology Author(s): Kak Khee Yeung, Menno Groeneveld, Joyce Ja-Ning Lu, Pepijn van Diemen, Vincent Jongkind, Willem Wisselink Open surgical repair of an aortic aneurysm requires aortic cross-clamping, resulting in temporary ischemia for all organs and tissues supplied by the aorta distal to the clamp. Major complications of open aneurysm repair due to aortic cross clamping include renal ischemia-reperfusion injury and postoperative colonic ischemia in case of supra- and infrarenal aortic aneurysm repair. Ischemia-reperfusion injury results in excessive production of reactive oxygen species and in oxidative stress, which can lead to multiple organ failure. Several perioperative protective strategies have been suggested to preserve renal function during aortic cross-clamping, such as pharmacotherapy and therapeutic hypothermia of the kidneys. In this chapter we will briefly discuss the pathophysiology of ischemia-reperfusion injury, as well as preventative measures that can be taken in order to avoid abdominal organ injury. Finally, techniques to minimize the risk of complications during and after open aneurysm repair will be presented.
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research