title: [Type A dissection. Principles of anesthesiological management].
abstract: Acute type A dissection is among the most dangerous of vascular diseases and is associated with a high lethality. Surgery for type A dissection is a complex procedure which is accompanied by relevant blood losses and severe deterioration of the coagulation system. Either due to the dissection or the surgical procedure, perfusion of affected organs can be diminished or completely disrupted with the risk of irreversible organ damage especially in the brain. Perioperative anesthesiological management for type A dissection is demanding and involves maintaining hemodynamic stability, surveillance of cerebral oxygenation and transesophageal echocardiographical diagnostic support for the decision-making of the most appropriate surgical approach. Furthermore, reestablishment of sufficient hemostasis can be challenging and requires thorough understanding of the relevant aspects affecting normal hemostasis during surgical repair of aortic dissection. In this article relevant pathophysiological aspects and basic principles of anesthesiological management of type A dissection are described.
authors.affiliation: Klinik für Anaesthesiolgie und Intensivmedizin, Universität Heidelberg, Im Neuenheimer Feld 110, Heidelberg, Germany. Jens.roggenbach@med.uni-heidelberg.de
authors.forename: J
authors.initials: J
authors.lastname: Roggenbach
authors.forename: H
authors.initials: H
authors.lastname: Rauch
mesh_terms: D000758:Anesthesia; D000784:Aortic Dissection / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation / Q000502:physiology; D050792:Circulatory Arrest, Deep Hypothermia Induced; D017548:Echocardiography, Transesophageal; D006801:Humans; D006863:Hydrogen-Ion Concentration; D016343:Monitoring, Intraoperative; D018570:Risk Assessment; D009626:Terminology as Topic; D014656:Vascular Surgical Procedures / Q000379:methods*