[Anesthetic management of total aortic arch reconstruction by transluminally placed Inoue endovascular branched stent graft].

Two aged patients with aortic arch aneurysm underwent total aortic arch reconstruction using three branched Inoue transluminal endovascular graft. Epidural tubes were placed for intraoperative analgesia the day before operation. General anesthesia was induced with propofol and midazolam, and maintained with sevoflurane in nitrous oxide and oxygen. Laryngeal mask airways were inserted and the patients breathed spontaneously. In the first case, she awoke smoothly without any complications during and after the operation. In the second case, she did not awake after the operation. The CT scan revealed multiple cerebral embolization. She died from multiple organ failure several days after the operation. Endovascular total aortic arch reconstruction with Inoue branched stent graft may be less invasive for aged patients than conventional surgical repair. But long-term mortality and effectiveness for this treatment remain unclear and severe complications such as cerebral infarction may occur. It is very important to let patients awake smoothly after operation and to estimate neurological findings as soon as possible.