Pulmonary Hypertension in the Perioperative Period-Focus on Current and Emerging Therapies

2015 ◽  
Vol 9 (1) ◽  
pp. 38-50 ◽  
Author(s):  
Harish Ramakrishna
Keyword(s):  
Pulmonary Hypertension ◽  
Perioperative Period ◽  
Emerging Therapies

scholarly journals Preoperative preparation of patients with arterial or pulmonary hypertension in noncardiac surgery

2011 ◽  
Vol 58 (2) ◽  
pp. 19-24 ◽  
Author(s):  
Branislava Ivanovic ◽  
Marijana Tadic ◽  
Dejan Markovic ◽  
Zeljko Bradic ◽  
Radmilo Jankovic ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Arterial Hypertension ◽  
Preoperative Evaluation ◽  
Perioperative Period ◽  
Cardiovascular Complications ◽  
Noncardiac Surgery ◽  
Channel Blockers ◽  
Preoperative Treatment ◽  
Cardiac Morbidity ◽  
Phosphodiesterase Type

Arterial hypertension is not an independent risk factor in cardiovascular complications in noncardiac surgery. Nevertheless, preoperative evaluation is necessary and includes estimation of arterial hypertension grade and possible damage of target organs. In patients with first and second grade of arterial hypertension postponement of elective intervention is not necessary, only optimization of therapy. On the other hand, patients with third level arterial hypertension have benefit if intervention is postponed till the reduction of arterial pressure. There is no indication that any of the antihypertensive drug groups has advantage in the preoperative treatment of hypertension. Unlike arterial hypertension pulmonary hypertension increases the risk of cardiac morbidity and mortality in the perioperative period. In patients with pulmonary hypertension, anesthesia and surgery may be complicated with heart failure, hypoxia and arrhythmias. Preoperative and postoperative treatments include calcium channel blockers, prostanoids, endothelin receptor antagonists and inhibitors of phosphodiesterase type 5.

Novel and Emerging Therapies for Pulmonary Hypertension

2014 ◽  
Vol 189 (4) ◽  
pp. 394-400 ◽  
Author(s):  
Soni Savai Pullamsetti ◽  
Ralph Schermuly ◽  
Ardeschir Ghofrani ◽  
Norbert Weissmann ◽  
Friedrich Grimminger ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Emerging Therapies

Emerging therapies for the treatment of pulmonary hypertension

2010 ◽  
Vol 11 ◽  
pp. S85-S90 ◽  
Author(s):  
Kurt R. Stenmark ◽  
Marlene Rabinovitch
Keyword(s):  
Pulmonary Hypertension ◽  
Emerging Therapies

Pulmonary Thromboendarterectomy

2019 ◽  
pp. 85-94
Author(s):  
Michael Ross ◽  
Dalia A. Banks
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Output ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Perioperative Period ◽  
Pulmonary Emboli ◽  
Severe Pulmonary Hypertension ◽  
Pulmonary Thromboendarterectomy ◽  
Thromboembolic Pulmonary Hypertension ◽  
Intimal Layer ◽  
Right Heart Dysfunction

Chronic thromboembolic pulmonary hypertension (CTEPH) is an important and often underappreciated cause of severe pulmonary hypertension. The disease is a result of incomplete resolution or recurrent pulmonary emboli. It is imperative to identify patients with CTEPH because it is one of the only causes of pulmonary hypertension that is curable. The treatment of choice is pulmonary thromboendarterectomy. The procedure involves removing any chronic thrombotic material and removing the intimal layer of the vasculature. Patients with CTEPH can be particularly challenging to manage in the perioperative setting and often present to the operating room with significant right heart dysfunction, severely elevated pulmonary vascular resistance, and reduced cardiac output.1 Increased knowledge about the unique disease and procedure can aid in optimizing the management of these patients in the perioperative period.2

Intraoperative Management of Patients with Pulmonary Hypertension

2013 ◽  
Vol 12 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Rafael Ortega ◽  
Christopher W. Connor
Keyword(s):  
Pulmonary Hypertension ◽  
Perioperative Period ◽  
Hemodynamic Instability ◽  
Right Ventricular Failure ◽  
High Morbidity ◽  
Ventricular Failure ◽  
Moderate Sedation ◽  
Relative Risks ◽  
Intraoperative Management ◽  
Anesthetic Considerations

Patients with pulmonary hypertension are some of the most challenging for an anesthesiologist to manage. Pulmonary hypertension in patients undergoing surgical procedures is associated with high morbidity and mortality due to right ventricular failure, arrhythmias and ischemia leading to hemodynamic instability, and intra- and postoperative hypoxia. Considering the challenges that these patients pose in the perioperative period, it is critical for anesthesiologists, surgeons, and other physicians who care for these patients to be well versed in managing pulmonary hypertension. The purpose of this article is to review the anesthetic considerations that pertain to patients with pulmonary hypertension in the perioperative period, with particular emphasis on the choice of anesthesia, the relative risks of moderate sedation and general anesthesia, and the most recent intraoperative monitoring recommendations.

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