SVS Guidelines Bundle

Abdominal Aortic Aneurysm

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19 Choice Of Anesthetic Technique And Agent ➤ The SVS recommends general endotracheal anesthesia for patients undergoing open aneurysm repair. (1-A) Antibiotic Prophylaxis ➤ The SVS recommends intravenous administration of a first-generation cephalosporin or, in the event of penicillin allergy, vancomycin within 30 minutes before OSR or EVAR. Prophylactic antibiotics should be continued for ≤24 hours. (1-A) ➤ The SVS recommends that any potential sources of dental sepsis be eliminated ≥2 weeks before implantation of an aortic prosthesis. (G-U) Intraoperative Fluid Resuscitation And Blood Conservation ➤ The SVS recommends using cell salvage or an ultrafiltration device if large blood loss is anticipated. (1-B) ➤ If the intraoperative hemoglobin level is <10 g/dL and blood loss is ongoing, the SVS recommends transfusion of packed blood cells along with fresh frozen plasma and platelets in a ratio of 1:1:1. (1-B) Cardiovascular Monitoring ➤ The SVS suggests using pulmonary artery catheters only if the likelihood of a major hemodynamic disturbance is high. (1-B) ➤ The SVS recommends central venous access and arterial line monitoring in all patients undergoing open aneurysm repair. (1-B) ➤ The SVS recommends postoperative ST-segment monitoring for all patients undergoing open aneurysm repair and for those patients undergoing EVAR who are at high cardiac risk. (1-B) ➤ The SVS recommends postoperative troponin measurement for all patients with electrocardiographic changes or chest pain after aneurysm repair. (1-A) Maintenance of Body Temperature ➤ The SVS recommends maintaining core body temperature ≥36ºC during aneurysm repair. (1-A)

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