Anesthetic Management of Acute Aortic Dissection

The anesthetic and perioperative management of patients with acute aortic dissection is important for achieving successful outcomes. Because early mortality is contingent on the time to definitive treatment, open communication between the admitting, surgical, and anesthesia teams is necessary to safely expedite the management of patients with life-threatening complications such as aortic regurgitation, cardiac tamponade, or malperfusion who require emergency operation. The wide availability of intraoperative transesophageal echocardiography (TEE) has enabled aortic dissection to be diagnosed or confirmed in the operating room. TEE can also diagnose complications associated with acute aortic dissection, identify the location of the intimal tear, characterize the extent of the dissection or guide central cannulation for cardiopulmonary bypass. During operations on the thoracic aorta, the brain, spinal cord, and end-organs require protection during periods of ischemia. Postoperative intensive care is necessary for temporary mechanical ventilatory support and circulation management with vasoactive medications. In addition, lung injury, acute kidney injury, encephalopathy, bleeding, mesenteric ischemia, limb ischemia, and metabolic acidosis are common problems that require critical care after operations for acute aortic dissection.