Surgical Repair of Abdominal Aortic Aneurysm under Epidural Anesthesia in Patient with Chronic Obstructive Pulmonary Disease -A case report-

만성 폐쇄성 폐질환 환자에서 자발 호흡를 유지한 상태하의 복부 대동맥류 수술 -1예 보고-

  • Park Sung-Yong (Department of Thoracic and Cardiovascular Surgery, Yong Dong Severance Hospital, Yonsei University College of Medicine) ;
  • Hong You-Sun (Department of Thoracic and Cardiovascular Surgery, Yong Dong Severance Hospital, Yonsei University College of Medicine) ;
  • Lee Gi-Jong (Department of Thoracic and Cardiovascular Surgery, Yong Dong Severance Hospital, Yonsei University College of Medicine) ;
  • Yu Song-Hyeon (Department of Thoracic and Cardiovascular Surgery, Yong Dong Severance Hospital, Yonsei University College of Medicine)
  • 박성용 (연세대학교 의과대학 영동세브란스병원 흉부외과) ;
  • 홍유선 (연세대학교 의과대학 영동세브란스병원 흉부외과) ;
  • 이기종 (연세대학교 의과대학 영동세브란스병원 흉부외과) ;
  • 유송현 (연세대학교 의과대학 영동세브란스병원 흉부외과)
  • Published : 2006.10.01

Abstract

Chronic pulmonary obstructive disease is known to be a significant risk factor for mortality in patients who under-went operation for abdominal aortic aneurysm. To decrease perioperative respiratory complication in these patients, maintenance of self respiration as possible is one of the better method. A seventy-seven year old male patient complained of abdominal pain and he was diagnosed for 9 cm sized abdominal aortic aneurysm. But he had severe chronic obstructive pulmonary disease which was expected to increase surgical mortality. So we introduced epidural anesthesia with maintenance of self respiration and performed surgical resection and graft replacement of abdominal aorta, and he recovered without any complication.

복부 대동맥류의 수술에 있어서 만성 폐쇄성 폐질환은 수술 사망에 유의한 영향을 미치는 위험 인자로 알려져 있다. 따라서 수술 후 호흡기 합병증을 줄이기 위해서는 강제적 기계 호흡을 줄이고 가능한 환자의 자발 호흡을 유지하는 것이 수술 결과를 향상시킬 수 있다. 본 증례에서는 복부 통증을 주소로 내원한 77세의 남자 환자로 수술 전 검사에서 약 9 cm크기의 복부 대동맥류가 발견되었으나, 심한 만성 폐쇄성 폐질환이 동반되어 수술 후 사망률이 높을 것으로 예상된 경우에서 경막외 마취등을 통해 환자의 자발 호흡을 유지한 상태로 복부 대동맥류 절제 및 인조혈관 삽입술을 시행하여 좋은 결과를 얻을 수 있었다.

Keywords

References

  1. Van Laarhoven CJ, Borstlap AC, Van Berge Henegouwen DP, Palmen FM, Verpalen MC, Schoemaker MC. Chronic obstructive pulmonary disease and abdominal aortic aneurysms. Eur J Vasc Surg 1993;7:386-90 https://doi.org/10.1016/S0950-821X(05)80254-3
  2. Sakamaki F, Oya H, Nagaya N, Kyotani S, Satoh T, Nakanishi N. Higher prevalence of obstructive airway disease in patients with thoracic or abdominal aortic aneurysm. J Vasc Surg 2002; 36:35-40 https://doi.org/10.1067/mva.2002.123087
  3. Lindholt JS, Jorgensen B, Klitgaard NA, Henneberg EW. Systemic levels of cotinine and elastase, but not pulmonary function, are associated with the progression of small abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 2003;26: 418-22 https://doi.org/10.1016/S1078-5884(03)00177-1
  4. Calligaro KD, Azurin DJ, Dougherty MJ, et al. Pulmonary risk factors of elective abdominal aortic surgery. J Vasc Surg 1993; 18:914-20 https://doi.org/10.1067/mva.1993.51369
  5. Iwakura H, Kishimoto T, Takatori T, Koh J, Nakamura Y, Kosaka Y. Anesthetic management of a patient with abdominal aortic aneurysm (AAA) with giant bulla. Masui 1994;43:116-8
  6. McGregor WE, Koler AJ, Labat GC, Perni V, Hirko MK, Rubin JR. Awake aortic aneurysm repair in patients with severe pulmonary disease. Am J Surg 1999;178:121-4 https://doi.org/10.1016/S0002-9610(99)00153-1
  7. Compton CN, Dillavou ED, Sheehan MK, Rhee RY, Makaroun MS. Is abdominal aortic aneurysm repair appropriate in oxygen-dependent chronic obstructive pulmonary disease patients? J Vasc Surg 2005;42:650-3 https://doi.org/10.1016/j.jvs.2005.03.066