Trauma - Supra coeliac aortic control Flashcards
(20 cards)
What is the abdominal approach used for?
To gain control of the aorta in surgical scenarios
It can take time to get adequate exposure via abdominal approach, especially in a large patient.
How is the aorta positioned when approached via thoracotomy?
In a more fixed position
What should be warned to anesthesia before cross-clamping the aorta?
High risk of cardiovascular instability
What technique can be applied to achieve temporary control of the aorta?
Direct pressure against the vertebra
What are the key steps for exposure in aortic surgery?
Mobilize liver and stomach
What should be done to expose the diaphragmatic hiatus?
Mobilize the left lobe of the liver and retract it with a Deaver or similar instrument
What ligament should be divided to aid in mobilization?
Gastrohepatic ligament
Which organ should be retracted to identify the esophagus?
Stomach
What should you ideally get around the esophagus for retraction?
A Penrose drain
What should you feel but not see during the procedure?
The aorta
What instrument can be used for aortic compression?
U-shaped aortic compression instrument
Where is it easier to clamp the aorta?
Enter the chest where there is less dense connective tissue
What should be transected at the 2 o’clock position?
A few centimeters of the left diaphragmatic crus
What can result from injury to the left gastric artery?
Complications during aortic surgery
What significant adverse effects can result from aortic cross-clamping?
Visceral ischemia and reperfusion injury
What can minimize the duration of visceral ischemia?
Shunting and left heart bypass
What should be monitored postoperatively to detect visceral ischemic injury?
Serial abdominal examinations and blood gas monitoring
What can postoperative renal dysfunction result from?
Significant loss of renal blood flow during cross-clamping
What can help prevent renal injury during surgery?
Adequate hydration and optimizing circulating blood volume
What complications can arise from clamping-induced spinal cord ischemia?
Paraplegia and paraparesis
