Perioperative management of open abdominal infrarenal aortic aneurysmal repair in a resource poor setting

Background: Aortic aneurysmal repair is associated with unique perioperative challenges which are often worsened by coexisting illnesses. We report five cases of infra-renal abdominal aneurysmal repairs which were done in Port Harcourt, Nigeria. Methods: Consenting adult patients presenting with infrarenal abdominal aortic aneurysm for open repairs between January 2019 and June 2024 were recruited in this study. Abdominal ultrasonography and CT angiography were commonly used diagnostic tools, while clinical details of patients’ demographics, history including drug history and ancillary investigation details were retrieved from patients’ and ICU data base of the hospitals. All patients were optimized prior to elective open surgery and haemodynamically stable during the perioperative periods and postoperatively admitted into the intensive care units. Results. Five patients aged 46years to 65years with average aneurysmal diameter of 7.7cm (range 6.5cm – 8.1cm) had satisfactory open repairs using trouser grafts. A combination of general anaesthesia and thoracic epidural anaesthesia were effective anaesthesia techniques with smoother perioperative course using a combination of intravenous propofol, isoflurane and epidural bupivacaine to manage elevated blood pressure changes at cross-clamping. Post clamping hypotension was managed with phenylephrine and norepinephrine. Postoperative analgesia was managed with epidural morphine, diclofenac suppository and intravenous paracetamol. All five patients had successful repairs. Two patients with unplanned prolonged cross clamping above two hours suffered spinal cord ischaemia with clinical lower limb paresis which was self-limiting. Conclusion: In resource limited environments, GA using propofol and isoflurane and thoracic epidural morphine/ bupivacaine could be utilized to manage cross clamping blood pressure changes during infra renal open abdominal aortic aneurysmal repairs with excellent outcome.