Vascular anaesthesia

Question 1

What is the STANFORD classification of aortic dissection?

Answer 1

Stanford A: involves ascending +/- descending aorta

Stanford B: involves descending aorta only

Question 2

What is the DEBAKEY classification of aortic dissection?

Answer 2

Debakey I: involves BOTH ascending AND descending aorta
Debakey II: Ascending only
Debakey III: Descending only

Question 3

List the clinical features of a aortic dissection.

Answer 3

SYMPTOMS
- Sudden onset, severe, stabbing chest pain
- Back/abdominal pain
- ACS
- Syncope
SIGNS
- Tachycardia
- New diastolic murmur (AR)
- Differential pulses
- ACS
- Hyper/Hypotension
- Stroke

Question 4

Is there a specific biomarker for aortic dissection?

Answer 4

Smooth muscle myosin heavy chain protein. Not widely available.

Question 5

What is a good target BP for management of acute aortic dissection?

Answer 5

100-110 mmHg systolic

Question 6

What is the first line management for hypertension in acute aortic dissection?

Answer 6

Beta blockers:

• Labetolol 50mg over 1 min IV push with infusion of 1-2 mg/min titrated to response
• Esmolol 500 mpg/kg over 1 min with infusion of 50-200 mpg/kg/min titrated to response. Bolus as above for each infusion dose adjustment.

Question 7

What is NASCET?

Answer 7

North American Symptomatic Carotid Endarterectomy Trial

Question 8

What is NASCET show?

Answer 8

For 50 - 69% stenosis, NNT = 10 to prevent stroke or death at 30 days, NNT = 15 for ipsilateral stroke prevention at 5 years.

Question 9

What is ECST?

Answer 9

European Carotid Surgery Trial

Question 10

What did ECST show?

Answer 10

NNT = 9 for 80-100% stenosis to prevent major stroke or death at 3 years

Question 11

What are the NICE recommendations for CEA following TIA

Answer 11

Perform within 2 weeks (48 hours preferable)