A review of anaesthesia for ruptured abdominal aortic aneurysm with special emphasis on preclamping fluid resuscitation.

Ruptured abdominal aortic aneurysm (RAAA) remains a critical emergency with an average hospital mortality of 50%. There has been no significant improvement in survival despite advances in anaesthesia, surgery and intensive care over the last 30 years. It is believed that early diagnosis, aggressive surgical management and meticulous attention to haemodynamic status and coagulation may improve survival, but this is unsubstantiated. Mortality is closely linked to the degree of preoperative hypotension and other related factors such as massive blood transfusion and cardiac arrest. Survival depends not only on the severity of rupture, but also the ability to compensate physiologically, and is linked to the premorbid state of the patient. Management priorities are dictated chiefly by the clinical signs and symptoms at presentation. There is controversy regarding the appropriate preoperative fluid regimen for RAAA.