Selektif Serebral Perfüzyon Uygulanan Aortik Ark Cerrahisi Olgularinda Anestezi Yönetimi ve Prognozun Geriye Dönük Değerlendirilmesi.

Introduction: This retrospective study was planned to analyse and report the patient characteristics, operative findings, intraoperative surgical and anesthetic management, intraoperative spectral edge frequency (SEF) values determined from EEG, postoperative inotrophic support and the complications in aortic reconstructive surgery (ARS) cases done with moderate hypothermia and antegrad selective cerebral perfusion (SCP) method. Material and Method: Twenty six patients whom we were able to reach their medical records completely, out of 150 patients, who had ARS done with SCP method in 2006, were retrospectively examined. Patients' demographic data, co-existent disease, cardiopulmonary by-pass, SCP and operation periods and length of ICU and hospital stay, postoperative neurologic outcome & other complications were recorded. SEF data determined from intraoperative EEG, were examined following induction of anaesthesia (1), early after CPB (2), during SCP period (3), X-clamp removal (4) and during sternum wiring (5). Statistical analysis included Friedman's two-way analysis of variance and Siegel N and Castellan J multiple comparison tests. For left and right hemisphere value comparison Wilcoxon Rank test was used. p<0.05 considered significant. Results: Seventeen patients had Type I (% 65.4), 1 had Type 2 dissection (% 3.8) and 8 had ascendan aortic aneurysm (% 30.8). Mean age was 54±92 years, SCP period 39±07min, CPB period 151.42±47.2min, ICU stay 13.7±24.3days & hospital stay was 20.65±24.1 days. Irreversible neurological complication was detected in 3 patients, 2 of whom died from MOF. Two patients who had reversible neurological complication discharged from the hospital uneventfully. Total of 4 deaths occurred. Bilateral SEF values of all patients decreased significantly in the 3rd period compared to 1st measurement period and tend to increase in the 5th period but this was not significant. No significant difference in SEF values of right and left hemisphere was noted during any measurement period. Conclusion: Besides using moderate hypothermia and selective cerebral perfusion method during ARS, patients' co-existent disease, history of cerebro-vascular accident, the length of SCP and CPB periods and many other factors seems to affect both morbidity & mortality. We believe that multiple neurologic monitorization for cerebral protection may be more effective in anaesthetic management of aortic reconstructive surgery. [ABSTRACT FROM AUTHOR]