Monitoring ECG leads II and V 5 will maximize the anesthesiologist's ability to recognize myocardial ischemia. Though not reported in these patients, transesophageal echocardiography could provide the observer with a more timely diagnosis of ischemic myocardial dysfunction. Those patients with poor left ventricular function, congestive heart failure, or significant pulmonary dysfunction may not be able to remain supine for the duration of the procedure without receiving general anesthesia. Likewise, a general anesthetic may be necessary for patients with chronic low back pain who may not tolerate lying still for the entire procedure. At Texas Heart Institute, endovascular stent repairs of abdominal aortic aneurysms are currently performed by cardiologists in the cardiac catheterization laboratory.
All patients receive general anesthesia.
Patients receive a large bore central venous catheter. At least two units of homologous packed red blood cells are available in the room. Heat conservation is employed. Appropriate lead garments and leaded glass shielding is utilized to protect all personnel from radiation exposure. Despite a high percentage of patients with significant pulmonary disease, most patients are successfully extubated at the completion of the procedure, prior to transport out of the catheterization lab.