Provision of vascular anaesthesia service UMMC
At present, the number of Malaysians aged 60 years and above is estimated to be 1.4 million and is projected to increase to 3.3 million in the year 2020. Parallel to increasing elderly population, there is an exponential increase in number of abdominal aorta aneurysm, along with increasing vascular pathologies such as limb ischemia, carotid artery stenosis.
Provision of vascular anaesthesia include ensuring stability for elderly which most often are the very fragile population with multiple comorbidities. Open abdominal aneurysm repair is a very high risk surgery with potential blood loss, fluid shift and potential of multiorgan failure. Our group aim to provide an enhance recovery after surgery starting from a team of decision making through multi team discussion where we gather a team of surgeon, cardiologist, radiologist and physician to make a throughout and collection decision and risk prior to surgery and anaesthesia. This will follow by pre-habilitation, pre-operative risk assessment and optimisation. Intraoperative care consist of vital organ protections and provision of stable anaesthesia.
Endovascular aneurysm repair (EVAR) is emerging to reduce the risk confer with open abdominal aneurysm repair. Such procedures include vascular anaesthetists provide clinical care in a hybrid theatre or the interventional radiology suite. In addition, a very large proportion of vascular surgery is urgent in nature. This is commonly highlighted in patients who require lower limb revascularisation, major lower limb amputation or carotid endarterectomy.
Vascular anaesthesia comprised of a team of trained anaesthetist with expertise in vital organ such as spinal cord, brain and kidney protection and can convert to open coronary bypass circuit in emergency rupture of thoracoabdominal aneurysm. In addition, we are trained in monitoring of anticoagulation, visceral perfusion and one-lung ventilation. We also provide regional anaesthesia for brachiocephalic / basilic access creation and transposition.
Vascular anaesthesia service also requires use of large amount of ancillary equipment such as rapid fluid infuser, cell salvage machine, advanced hemodynamic monitoring, and transoesophageal echocardiography. University Malaya Medical Centre is equipped with a designated hybrid operation theatre to assist in endovascular procedures while offer the back-up of extracorporeal circulation.