Perioperative Anaesthesia Management for Aorta Dissection Patient Undergo Bentall Procedure

Abstract

Introduction: aortic dissections that involve the ascending aorta (Stanford type A) are considered surgical emergencies. The mortality rate without emergency surgery is about 1% per hour for the first 48 hour, 60% by about one week, 74% by 2 weeks and 91% by 6 month. Open chest surgery with resection of dissected aorta may reduce the expected fatal outcomes to 10% as soon as the treatment provided in the first 24 hour and 20% for next 14 day. Case: A case of 42 years old man, 72 kg weight complained of sharp, tearing, pain from upper abdomen to chest and back of body since a month before admission. The pain endured for 20 minutes, patient had history of hypertension a year ago. Suspected with aortic dissection patient transferred to CVCU got therapy of antihypertension and β-blocker. Laboratory examination showed kidney disorder with enhancement of Ureum and creatinine levels. CT contras showed aortic dissection Stanford A Debakey Type I and patient scheduled for Bentall Procedure with complication Acute Kidney Injury (AKI). Perioperative anaesthesia management from preoperative with β-blocker and ramipril, induction with high dose analgetic, smooth intubation prevent increase in systolic blood pressure and heart rate, also maintain oxygen delivery to brain when DHCA started use SACP monitored with NIRS. after operation patient treated in ICU with ventilator and full sedated. Second day in ICU patient developed high creatinine levels and low urine output per hour. Renal replacement therapy is given and patient transfer to CVCU on the fifth day. Conclusion: it is still challenging to treatment of aortic dissection, started from diagnosis, preoperative management and overcoming the complication. Therefore, careful history taking, early treatment to prevented expansion of dissected aorta, CT angiography for diagnosed, intraoperative management and haemodialysis therapy should be considered to increase patient outcome.