Anaesthetic management of patients undergoing surgery on the descending aorta

Surgical repair of the descending thoracic aorta remains a complex intervention with a definite risk although major advances in surgical techniques and anaesthesia practices have substantially reduced mortality and morbidity. A better understanding of the mechanism leading to the profound haemodynamic changes during clamping and unclamping of the proximal aorta has allowed the introduction of methods, for example distal perfusion techniques, to attenuate the haemodynamic sequelae of aortic cross-clamping. Anaesthesiologists caring for these patients should therefore be familiar with these techniques. Permanent ischaemic injury to end-organs distal to the aortic cross-clamp, most notably to the spinal cord resulting in paraplegia, remains a major concern. Some of the newer methods to reduce the incidence of this devastating complication are discussed in this chapter.