Anaes Vivas · Cardiac anaesthesia
Anaesthesia for aortic dissection and major aortic surgery — viva
Structured oral examination station for aortic-dissection-major-aortic.
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ANZCAFRCAEDAICABAFCAI
Prompt
Cardiac theatre stem focusing on anaesthesia for aortic dissection and major aortic surgery with a monitoring printout and TOE still available.
Opening
One-line answer: Type A dissection is a surgical emergency: control heart rate and blood pressure without delaying transfer, use TOE, prepare for CPB with possible DHCA and cerebral protection, and manage malperfusion and coagulopathy aggressively.
[2] [4] [5]References9ShowHide
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- [2]Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: ASE/SCA recommendations. 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: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. 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