Aaa Elective

AAA Elective • Long procedure, large fluid shift, and high risk of blood loss A→ N/A B→ potential COPD C→ CAD, HTN, Renal→ border line function • In the pre-op evaluation: concentrate on cardiac function with detailed H/P and work up • Lab: CBC-D, BUN, creat, Lytes, Mg, ECG, CXR, PFT, ABG, Echo if available • Consider optimizing any medical condition pre-op by meds, consultation, and further evaluation. • X-match for at least 6 U of blood, have FFP ready • Consider Epidural to do it as a combined technique • Have the cell saver in the room, IV worming device, with blood set • Lines: Big 14G peripheral IV, Art line, CVP/PAC, bear hugger • Monitors: standard + 5 leads ECG, Foley, temp, art-line, CVP/PAC, TEE • Induction: routine, modify on cardiac status • Before induction have inotrops and vasodilators ready to go

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For the epidural give a test dose xylo with epi watch BP and pulse If happy → titrate Marcaine with epi 0.125% + 1:400,000 + 50 ug fentanyl incremental 5 ml total 15 ml over 20 min then start infusion 0.0625+ 1:400,000 + 2 ug/ml 8-14 ml/hr Have heparin ready 100u/kg, give it at least one hr after the epidural With X-clamp: consider SNP 5 min before talking the clamp off hyperventilate, and have bicarb, CaCl ready, in addition to a vasopressor or inotrops