Anesthetic Management in Aortic Arch Surgery and Neuroprotection

Aortic arch surgery requires obligatory alteration or cessation of blood flow to the brain and the rest of the body to accomplish the repair. The successful outcome of operations involving the aortic arch is largely dependent on effective strategies for neuroprotection. Neuroprotective strategies include deliberate hypothermia, neurocirculatory management, and surgical techniques. These strategies are often used together and no single approach has been proven to be superior. Considerations for neuroprotection include pathophysiology of brain injury, rewarming and protection of system organs, and intraoperative monitoring. Postoperative complications can include neurologic complications, bleeding, malperfusion, and renal injury.