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Aortic DISSECTION AWARENESS

Writer: Shaun Nicosia
Shaun Nicosia
11 minutes ago
2 min read

Today, Emmanuel Mbaka, The African Perfusionist will explain: ๐—ช๐—ต๐˜† ๐—ช๐—ถ๐—น๐—น ๐—ช๐—ฒ ๐—–๐—ผ๐—ผ๐—น ๐—ฌ๐—ผ๐˜‚๐—ฟ ๐—•๐—ผ๐—ฑ๐˜† ๐——๐˜‚๐—ฟ๐—ถ๐—ป๐—ด ๐—”๐—ผ๐—ฟ๐˜๐—ถ๐—ฐ ๐—ฆ๐˜‚๐—ฟ๐—ด๐—ฒ๐—ฟ๐˜†?


Imagine being told before your operation:


โ€œDuring your surgery, we will cool your body.โ€


That statement alone can sound frightening.


You might immediately ask:


โ€œHow cold are you going to make me?โ€


In complex aortic surgery, particularly when we are operating on the aortic arch, cooling the body is an important part of how we protect you while the surgeon performs the repair.


Once you are safely supported by the heart-lung machine, we can gradually begin lowering your body temperature.


And we are not talking about becoming just slightly cold.


Depending on the operation and the protection strategy being used, your temperature may be lowered into approximately the 68โ€“82ยฐF (20โ€“28ยฐC) range. In some strategies requiring deeper hypothermia, temperatures around 64โ€“68ยฐF (18โ€“20ยฐC) may be used.


That sounds incredibly cold.


๐—ฆ๐—ผ ๐˜„๐—ต๐˜† ๐˜„๐—ผ๐˜‚๐—น๐—ฑ ๐˜„๐—ฒ ๐—ถ๐—ป๐˜๐—ฒ๐—ป๐˜๐—ถ๐—ผ๐—ป๐—ฎ๐—น๐—น๐˜† ๐—ฑ๐—ผ ๐˜๐—ต๐—ถ๐˜€?


Because cooling reduces the bodyโ€™s metabolic demand.


At normal body temperatureโ€”around 98.6ยฐF (37ยฐC)โ€”your organs continuously require oxygen and energy.


As we cool the body, metabolism slows. The brain and other organs can better tolerate periods of altered or reduced blood flow because their demand for oxygen has decreased.


Think of it as temporarily placing the body into a carefully controlled energy-saving mode.


But as the perfusionist, I donโ€™t simply turn down the temperature and wait.


Cooling is a controlled process.


While you are asleep, I am at the heart-lung machine monitoring your temperature at appropriate sites, blood flow, blood pressure, oxygen delivery, blood gases and many other parameters.


We communicate continuously with the surgeon and anesthesiology team:


Where is the temperature now?


Are we approaching our target?


Is the patient adequately cooled for the next stage of the operation?


We donโ€™t cool every patient to exactly the same temperature. The target depends on the part of the aorta being repaired, how long altered circulation is anticipated, whether cerebral perfusion will be used, the surgical teamโ€™s strategy, and characteristics of the individual patient.


Then, after the critical part of the repair has been completed, another important journey begins:


We start warming you again.


And just like cooling, rewarming must be controlled.


Gradually, we bring your temperature back toward normal while continuing to monitor your circulation, oxygen delivery and other physiologic parameters.


So when someone tells you:


โ€œDuring your aortic surgery, we will cool your body.โ€


Donโ€™t think of it simply as making you cold.


๐—ง๐—ต๐—ถ๐—ป๐—ธ: ๐—ฃ๐—ฟ๐—ผ๐˜๐—ฒ๐—ฐ๐˜๐—ถ๐—ผ๐—ป.


While the surgeon is repairing your aorta, we are deliberately changing the conditions inside your body to help protect your brain and other vital organs.


And while you are completely asleep and unaware that your temperature has fallen from around 98.6ยฐF toward 80ยฐF, 70ยฐF, or sometimes even the mid-60s Fahrenheit, someone at the heart-lung machine is watching every stage of that journey.


That is the perfusionistโ€™s perspective.



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