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cardiac
Must-have
Aortic Dissection Type A: Anesthetic Management
Stanford A (DeBakey I/II) ascending aortic dissection — emergent surgical repair under deep hypothermic circulatory arrest
Stanford Type A aortic dissection is a surgical emergency involving the ascending aorta — requires immediate operative repair under cardiopulmonary bypass with deep hypothermic circulatory arrest for arch involvement.
If you forget
Type A = ascending aorta = OR NOW — mortality 1-2%/hr untreated, ~50% within 48 h, ~75% within 2 wk
Board trap
"Why give esmolol BEFORE nitroprusside?" — Vasodilators alone cause reflex tachycardia, raising dP/dt and propagating the dissection. Impulse control MUST precede afterload reduction. Trap #2: avoid pure β-blockade in cocaine-induced dissection (unopposed α → phentolamine + benzo).
Key numbers
- SBP goal 100-120 mmHg; HR goal 60-80 bpm; MAP >70 if malperfusion
- Mortality 1-2%/hr untreated; ~50% within 48 h; ~75% within 2 weeks
- DHCA temp 18–22°C (deep hypothermia); safe cerebral ischemia ~30–40 min at 18°C
- Esmolol 500 mcg/kg bolus → 50-200 mcg/kg/min infusion
- TEE sensitivity ~95–98% for thoracic aortic dissection (blind spot at distal ascending aorta); CT angiography ~100% when stable
Reviewed Sep 15, 2026 for clinical accuracy by BoardsBridge Editorial Process
Drill this as a SOE stem →Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: ACC AHA Aortic Disease 2022 · ACC AHA Aortic Disease 2022
Re-review cadence: 12 months from reviewed date.
Related on BoardsBridge
Card ID: aortic-dissection-type-a · Path: aba.cardiac.great-vessels-and-pericardium.aortic-dissection-type-a