Hemodynamic therapy remains the foundation of aortic dissection (AD) care, and successful control of blood pressure and heart rate improves patient comfort. The first step in AD care, anti-impulse therapy, serves as optimal medical management and also provides pain relief. Ongoing pain after beta-blocker administration usually indicates incomplete blood pressure control. In such cases, pain relief (and optimal medical management) is facilitated by vasodilation. When AD is accompanied by cardiac ischemia, the calcium channel blocker nicardipine is indicated. Citing sedative and anxiolytic properties, expert reviewers recommend morphine for AD pain, but there is no evidence demonstrating its superiority over other opioids. Patients in pain from AD tend to be hypertensive, but in those cases where blood pressure is borderline or low, fentanyl's limited hemodynamic impact is attractive. Anesthesiologists confirm fentanyl's utility for AD, including in cases where there are complicating conditions such as subarachnoid hemorrhage or pregnancy.
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