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Typ-A-Dissektion

Prinzipien des anästhesiologischen Managements

Type A dissection

Principles of anesthesiological management

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Zusammenfassung

Die akute Typ-A-Dissektion gehört zu den gefährlichsten vaskulären Erkrankungen und ist mit einer hohen Letalität vergesellschaftet. Die operative Versorgung einer Typ-A-Dissektion stellt einen komplexen Eingriff dar, der häufig mit relevanten Blutverlusten einhergeht und zu schweren Gerinnungsstörungen führen kann. Sowohl die Typ-A-Dissektion als auch der chirurgische Eingriff selbst können, insbesondere im Gehirn, zu schweren Organischämien führen. Das perioperative Management stellt eine Herausforderung an den Anästhesisten dar und beinhaltet die Aufrechterhaltung einer adäquaten Hämodynamik, die Überwachung der zerebralen Oxygenierung sowie, mithilfe der transösophagealen Echokardiographie, die Unterstützung des Chirurgen bei der Entscheidung über das bestmögliche operative Vorgehen. Darüber hinaus ist die Wiederherstellung einer suffizienten Gerinnung anspruchsvoll und bedarf eines tief gehenden Verständnisses der relevanten Faktoren, die eine normale Hämostase während der operativen Versorgung einer Typ-A-Dissektion beeinflussen. In diesem Beitrag werden relevante pathophysiologische Aspekte und die Prinzipien des anästhesiologischen Managements der Typ-A-Dissektion beschrieben.

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 sugical repair of aortic dissection. In this article relevant pathophysiological aspects and basic principles of anesthesiological management of type A dissection are described.

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  1. Klinik für Anaesthesiolgie und Intensivmedizin, Universität Heidelberg, Im Neuenheimer Feld 110, 69115, Heidelberg, Deutschland

    J. Roggenbach DESA & H. Rauch

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  2. H. Rauch
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Correspondence to J. Roggenbach DESA.

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Roggenbach , J., Rauch, H. Typ-A-Dissektion. Anaesthesist 60, 139–151 (2011). https://doi.org/10.1007/s00101-010-1809-4

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