Hypotensive Therapy for Acute Aortic Dissection
The patient should be managed in a high dependency or intensive care unit.
- Make sure adequate analgesia has been given, as pain will contribute to hypertension.
- Consider placement of an arterial cannula to allow continuous BP monitoring. Put in a bladder catheter to monitor urine output.
- Start labetalol IV. Give a bolus of 20 mg over 2 min, followed by an infusion of 16 mg/min, increasing the infusion rate every 10 min as needed to achieve target systolic BP.
- Target systolic BP is 100120 mmHg within 2030 min, providing urine output remains >30 mL/h, and there is no other clinical evidence of organ ischaemia.
- If target BP is not achieved with labetalol 6 mg/min, add a nitrate infusion, for example isosorbide dinitrate 212 mg/h.
- Start or increase oral anti-hypertensive therapy.
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