From the Department of Anesthesiology, Washington University in St Louis, St Louis, Missouri.
Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota.
Anesth Analg. 2018 Dec;127(6):1302-1313. doi: 10.1213/ANE.0000000000003747.
Acute aortic syndromes are a distinct group of pathologies involving the wall of the aorta that present acutely and can be potentially fatal unless treated in a timely fashion. The syndrome is dominated by aortic dissections, which comprise ≥95% of all such presentations. Those involving the ascending aorta are particularly lethal and require specific and early surgical treatment compared to dissections involving other parts of the aorta. The surgical repair of an ascending aortic dissection presents multiple challenges to the anesthesiologist. Thoughtful management throughout the perioperative period is critical for minimizing the significant morbidity and mortality associated with this condition. In this narrative review, we provide an overview of the perioperative management of patients presenting for the surgical repair of an ascending aortic dissection. Preoperative discussion focuses on assessment, hemodynamic management, and risk stratification. The intraoperative section includes an overview of anesthetic management, transesophageal echocardiographic assessment, and coagulopathy, as well as surgical considerations that may influence anesthetic management.
急性主动脉综合征是一组涉及主动脉壁的特定病理学，其表现为急性，并可能致命，除非及时治疗。该综合征主要由主动脉夹层组成，占所有此类表现的≥95%。涉及升主动脉的夹层尤其致命，与涉及主动脉其他部位的夹层相比，需要特定和早期的手术治疗。升主动脉夹层的手术修复给麻醉师带来了多种挑战。在整个围手术期进行深思熟虑的管理对于最大限度地降低与这种情况相关的显著发病率和死亡率至关重要。在这篇叙述性综述中，我们提供了接受升主动脉夹层手术修复的患者围手术期管理概述。术前讨论侧重于评估、血流动力学管理和风险分层。术中部分包括麻醉管理概述、经食管超声心动图评估和凝血障碍，以及可能影响麻醉管理的手术考虑因素。
