Aortic Dissection Flashcards
What is an aortic dissection?
A tear in the intima of the aorta
What are the types of aortic dissection-Stanford
Type A: begins in ascending aorta
Type B: begins in descending aorta
Type A requires what to fix?
surgery to repair aorta and aortic valve and coronaries-requires CPB
Type B-can it be treated medically?
Yes, medically or endovascularly
What are risks for aortic dissection?
Atherosclerosis, HTN, blunt trauma, bicuspid aortic valve, coarctation of aorta, Ehlers-Danlos syndrome, Marfan syndrome, pregnancy
Complications of Aortic dissection:
hemorrhage/shock, emboli, stroke, renal failure
How would pts with aortic dissectio present as far as symptoms?
chest pain-sudden, severe, sharp, stabbing, taring, radiating to scapula/back
Or-s/p chest trauma? confusion, anxiety, thirst, dyspnea
Physical exam of aortic dissection:
acute distress/loc, difference in BP (greater than 20 mmHg)-Right versus left, pleural effusion, wide mediastinum on CXR,
rapid weak pulse, AI (diastolic murmur), distant heart sounds (pericardial effusion)
What kind of tests do you want to get in Aortic dissection? Would you consult anyone?
aortic angiography, chest MRI/CT, echocardiogram, TEE, CXR, EKG, CBC, electrolytes, coags, BUN/CR, type and sceen. Consult cardiothoracic surgery
What kind of induction do you want to do?
Slow, titrated induction
What are your goals for optimization in these aortic dissection patients?
strict control of BP required (SBP <115)-
AVOID HTN-use beta blocker before vasodilator
Consider EEG, SSEP, MEP
Type A-risk of ?
Type B-risk of?
Type A; risk of stroke
Type B: spinal cord ischemia is a concern (SSEP, MEP, Lumbar drain)
Options for anesthesia in Aortic dissection?
GETA/CPB +/- deep hypothermic arrest
GETA/MAC/local (type B)
Room setup for aortic dissection:
Standard monitors, foley catheter, arterial monitor, +/- CVP monitor, +/- PAC, +/- TEE
Vasopressors/inotropes; heparin
How are you going to maintain anesthesia in patients with aortic dissection?
balanced technique
