IntroductionOptimal surgical management for acute type A aortic dissection (AAAD) remains unclear. The in-hospital mortality rate is still high (15%), and the intraoperative bleeding is an independent risk factor for hospital mortality.ObjectiveThe aim of our study was describe a new method for aortic anastomosis in the repair of AAAD and report the hospital mortality and bleeding complications.MethodsBetween January 2008 and November 2014, 24 patients, 16 male, median age 62 years, underwent surgical treatment of AAAD. The surgical technique consisted of intussusception of a Dacron tube in the dissected aorta, which is anastomosed with a first line of 2-0 polyester everting mattress suture and a second line of 3-0 polypropylene running suture placed at the outermost side. Open distal anastomosis was performed with bilateral selective antegrade cerebral perfusion in 13 (54.1%) patients.ResultsCardiopulmonary bypass and aortic clamping time ranged from 75 to 135 min (mean=85 min) and 60 to 100 min (mean=67 min), respectively. The systemic circulatory arrest ranged from 29 to 60 min (mean=44.5 min). One (4.1%) patient required reoperation for bleeding, due to the use of preoperative clopidogrel. The postoperative bleeding was 382-1270 ml (mean=654 ml). We used an average of 4.2 units of red blood cells/patient. There were two (8.3%) hospital deaths, one due to intraoperative bleeding and another due to mesenteric ischemia. The average length of stay in the intensive care unit and hospital was 44 hours and 6.7 days, respectively.ConclusionThis new method for surgical correction of AAAD was reproducible and resulted in satisfactory clinical outcomes.

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Critically ill and/or anticoagulated patients remain a great challenge for anesthesiologists regarding the anesthetic procedure. Its perioperative management should focus on organ preservation and avoid further damage. In this context, ultrasound-guided regional blocks are essential tools, as they avoid neuraxial invasion and deterioration in borderline hemodynamics, conferred by spinal anesthesia and general anesthesia, respectively. In this report, we present a case of a patient with septic shock, anticoagulated, and in need of an emergency surgical approach in the right lower limb in which ultrasound-guided peripheral nerve block was essential for a favorable outcome for the patient. Case Report: Patient in septic shock in need of amputation of the right lower limb at the level of the thigh, with unstable hemodynamics and severe respiratory conditions, undergoing ultrasound-guided peripheral nerve block, of the right femoral, sciatic and lateral cutaneous nerves of the thigh, as a single anesthetic technique. Conclusion: Regional anesthesia of the peripheral nerve guided by ultrasound as a unique anesthetic technique, performed by experienced professionals or under supervision, is effective and safe for lower limb surgical procedures. We suggest this approach, especially in hemodynamically borderline patients or seriously ill with or without anticoagulation.