Der Anaesthesist
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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. ⋯ 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.
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Lidocaine is commonly used for regional anesthesia and nerve blocks. However, recent clinical studies demonstrated that intravenous perioperative administration of lidocaine can lead to better postoperative analgesia, reduced opioid consumption and improved intestinal motility. It can therefore be used as an alternative when epidural analgesia is contraindicated, not possible or not feasible. ⋯ The lidocaine infusion is stopped in the recovery room 30 min before discharge or in the ICU at the latest after 24 h. Lidocaine is not used on normal wards. This overview summarizes the current evidence for the intravenous administration of lidocaine for patients undergoing different types of surgery and gives practical advice for its use.