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Table 50.5

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 1–6 mg/min, increasing the infusion rate every 10 min as needed to achieve target systolic BP.
  • Target systolic BP is 100–120 mmHg within 20–30 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 2–12 mg/h.
  • Start or increase oral anti-hypertensive therapy.