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Hemodynamic and metabolic effects of aortic unclamping following emergency surgery for traumatic thoracic aortic tear in shunted and unshunted patients



Hemodynamic and metabolic effects of aortic unclamping following emergency surgery for traumatic thoracic aortic tear in shunted and unshunted patients



Journal of Trauma 31(7): 1007-15; Discussion 1015-6



Nine cases of traumatic aortic tear treated during 1986-1987 were reviewed. Two patients had functioning Gott shunts, six patients has simple crossclamp, and one patient had a Gott shunt placed which was nonfunctional. Anesthetic management was similar in all patients. Clamp times ranged in unshunted patients from 25 to 38 minutes, and in shunted patients from 42 to 50 minutes. The crossclamp time of the patient with the nonfunctional shunt was 42 minutes. Declamping was accompanied in unshunted patients by decreases in core temperature of up to 1.degree.C and acute decreases in PaO2. Marked respiratory and metabolic acidosis occurred with declamping. Respiratory acidosis resolved within 30 minutes wirh hyperventilation, but metabolic acidosis persisted despite bicarbonate therapy (mean = 1.2 mEq/kg) up to 6 hours after declamping. Associated elevations in serum potassium resolved as pH returned to baseline. Acid-base and electrolyte abnormalities were less marked in patients who were shunted.

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Accession: 007392578

Download citation: RISBibTeXText

PMID: 1906547

DOI: 10.1097/00005373-199107000-00022


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