Anesthetic Management of Laparoscopic Surgery in a Patient With an Uncomplicated Type B Aortic Dissection: A Case...

Aortic dissection is a rare but life-threatening condition requiring timely diagnosis and individualized management. Chronic type B aortic dissection is usually managed conservatively; however, anesthetic care during non-cardiac surgery poses unique challenges due to the risk of extension or rupture. We report the case of a 65-year-old hypertensive male with prior stroke who presented with symptomatic cholelithiasis. Preoperative imaging incidentally revealed a chronic Stanford type B aortic dissection extending from just distal to the left subclavian artery to the left common iliac artery. Cardiology and vascular surgery advised conservative management. He underwent laparoscopic cholecystectomy under general anesthesia with invasive monitoring. Induction was achieved with etomidate, morphine, and cisatracurium. Strict hemodynamic control was maintained with glyceryl trinitrate infusion, and intra-abdominal pressure was limited to 10 cm H₂O. The procedure lasted 54 minutes, was uneventful, and the patient recovered without complications. Anesthetic management of type B aortic dissection during laparoscopic surgery requires meticulous blood pressure and heart rate control to prevent dissection extension or rupture. Laparoscopic procedures increase intra-abdominal and systemic pressures, which can exacerbate aortic wall stress. In resource-limited settings, where short-acting agents may be unavailable, vigilant monitoring, multidisciplinary planning, and judicious use of available drugs such as morphine and vasodilators are essential to ensure patient safety. This case emphasizes the importance of perioperative vigilance, hemodynamic optimization, and multidisciplinary coordination in safely managing patients with chronic type B aortic dissection undergoing non-cardiac surgery.