Management of anesthesia in a patient with ruptured abdominal aortic aneurysm: A case report

Introduction: Abdominal aortic aneurysm is a multifactorial condition which associated with aging and atherosclerosis. During aneurysm surgery, hypotension after aortic clamp removing occure commonly that require specific treatments. This case report showes administration of blood and hemodynamic control methods after aortic unclumping during aortic aneurysm surgery. Patient: A 75–years-old woman who complained of back and flank pain initially diagnosed and hospitalized as pyelonephritis. In ultrasound a pulsatile mass in middle part of the abdomen and the abdominal aortic aneurysm was diagnosed for the patient. After surgery consultation, the patient was diagnosed as ruptured abdominal aortic aneurysm. Following removal of aortic clamp during surgery despite adequate volume administration and reducing the maintenance dose of anesthetic agents, sever hypotension was occurred that only by reclamping the aorta and its gradual opening effectively controlled in normal range. Conclusion: With mixture of therapeutic measures such as intravascular ressusitation, especially with hypertonic solution, we can applying the method of acute normovolemic Hemodilutionthe. By using PEEP and monitoring ETco2, during the aortic clamping phase and gradual opening of aortic clamp, we can anticipate and treat the hypotension after aortic unclamping.