Awake aortic aneurysm repair in patients with severe pulmonary disease

Background: We report the use of retroperitoneal aortic aneurysm repair utilizing exclusive regional anesthesia (no intubation or inhalation anesthetic) in high pulmonary risk patients. Methods: Six patients were retrospectively reviewed. Pulmonary disease was diagnosed by clinical history and pulmonary function tests. Patients received intravenous sedation and regional anesthesia. Retroperitoneal aortoiliac aneurysm repair was performed. Results: All patients used inhaled steroids and albuterol. Three required theophylline and home oxygen. FEV1 = 23% ± 5% predicted, FVC = 34% ± 5% predicted, and PO2 = 62 ± 2 mm Hg. Operative time was 247 ± 25 minutes. Blood loss was 840 ± 479 mL. Five of six patients (83%) tolerated awake aneurysm repair and had intensive care unit stays of 2.4 ± 0.6 days, and postoperative hospital stays of 8.2 ± 1.8 days. One patient was converted to general anesthesia and had a prolonged hospital stay. Conclusions: With thorough patient communication, awake retroperitoneal aortic aneurysm repair can be safely performed in select patients with severe pulmonary disease.