Continued from the operating room, the immediate focus of postoperative management centers on hemodynamic management and major volume resuscitation guided by PAC monitoring, ideally with continuous cardiac output and continuous mixed venous capability. Coagulation management should continue with consideration that as the patient is actively warmed, decreased venous return from vasodilation can contribute to lower cardiac output and MAP. Surgical trauma, fluid and coagulation resuscitation, and postoperative third-spacing contribute to challenges with oxygenation and ventilation for which inhaled nitric oxide may be considered. Serial arterial blood gas analysis for lactate, pH, and hemoglobin levels at least every hour is useful to monitor and guide resuscitation.

References

• Chatterjee S, Casar JG, LeMaire SA, Preventza O, Coselli JS. Perioperative care after thoracoabdominal aortic aneurysm repair: The Baylor College of Medicine experience. Part 2: Postoperative management. J Thorac Cardiovasc Surg. 2021;161:699-705.
• Khan FM, Naik A, Hameed I, et al. Open repair of descending thoracic and thoracoabdominal aortic aneurysms: a meta-analysis. Ann Thorac Surg. 2020;110:1941-1949.