Anaes SAQs · Cardiac anaesthesia
Anaesthesia for aortic dissection and major aortic surgery
Final-examination SAQ for aortic-dissection-major-aortic.
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ANZCAFRCAEDAICABAFCAI
Prompt
Discuss the anaesthetic management relevant to anaesthesia for aortic dissection and major aortic surgery, including exact monitoring targets and crisis priorities.
Model answer
Core facts. Reproduce surveyed heparin 300 IU/kg with ACT 400–480 s, protamine ~1 mg/100 IU (1:1 the surveyed commonest), taught CPB flows 2.2–2.5 L/min/m² and MAP 50–80 mmHg bands, and the TRICS III restrictive-threshold result (5,243 patients; 11.4 vs 12.5% composite, noninferior) where relevant.
[1] [8]Topic structure. Cover preoperative risk, lesion- or technique-specific goals, intraoperative sequence, TOE role, and the canonical crisis: Type A dissection with tamponade and malperfusion to theatre.[2][4][6]
Close. Disposition, ICU plan, and common traps.[1][9]
References9ShowHide
- [1]Mazer CD, Whitlock RP, Fergusson DA, et al. Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery (TRICS III). New England Journal of Medicine, 2017.PMID 29130845
- [2]Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. Journal of the American Society of Echocardiography, 2013.PMID 23998692
- [3]Levy JH, Ghadimi K, Kizhakkedathu JN, Iba T What's fishy about protamine? Clinical use, adverse reactions, and potential alternatives. Journal of Thrombosis and Haemostasis, 2023.PMID 37062523
- [4]Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease. Circulation, 2022.PMID 36322642
- [5]Suzuki T, Isselbacher EM, Nienaber CA, et al. Type-selective benefits of medications in treatment of acute aortic dissection (from the International Registry of Acute Aortic Dissection [IRAD]). American Journal of Cardiology, 2012.PMID 21944678
- [6]Hussain A, Uzzaman M, Mohamed S, et al. Femoral versus axillary cannulation in acute type A aortic dissections: a meta-analysis. Journal of Cardiac Surgery, 2021.PMID 34263486
- [7]Poon SS, Estrera A, Oo A, Field M Is moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion superior to deep hypothermic circulatory arrest in elective aortic arch surgery? Interactive Cardiovascular and Thoracic Surgery, 2016.PMID 27209532
- [8]Pereira RM, Guerra N, Ferreira R, et al. Contemporary Clinical Practices in Anticoagulation Management During Cardiopulmonary Bypass: a Europe-wide survey. Interdisciplinary Cardiovascular and Thoracic Surgery, 2026.PMID 41787968
- [9]Yoshitani K, Kawaguchi M, Kawamata M, et al. Cerebrospinal fluid drainage to prevent postoperative spinal cord injury in thoracic aortic repair. Journal of Anesthesia, 2021.PMID 32980925