Non-Cardiac General Surgery in Patients with Pulmonary Hypertension: Particularities of Perioperative Management

Pulmonary hypertension is a major reason for elevated perioperative morbidity and mortality, even in non-cardiac surgical procedures. Patients more often experience serious complications, such as right-ventricular failure, arrhythmias, and early postoperative death. Preoperatively patients should be thoroughly prepared for the intervention and allowed plenty of time for consideration. All specialty disciplines involved in treatment should play a role in these preparations. After selecting each of the suitable individual anesthetic and surgical procedures, intra operative management should focus on avoiding all circumstances that could contribute to exacerbating pulmonary hypertension (hypoxemia, hypercapnia, acidosis, hypothermia, hypervolemia, and insufficient anesthesia and analgesia). Due to possible induction of hypotension, intravenous vasodilators (milrinone, dobutamine, prostacyclin, Na-nitroprusside, and nitroglycerine) should be administered with the greatest care. A method of treating elevationsin pulmonary pressure with selective pulmonary vasodilation by inhalation should be available intraoperatively (iloprost, nitrogen monoxide, prostacyclin, and milrinone) in addition to invasive hemodynamic monitoring. During the postoperative phase, patients must be monitored continuously and receive sufficient analgesic therapy over an adequate period of time. All in all, perioperative management of patients with pulmonary hypertension presents an interdisciplinary challenge that requires the adequate involvement of anesthetists, surgeons, pulmonologists, and cardiologists alike. Central Sablotzki et al. (2015) Email: Clin Res Pulmonol 3(1): 1031 (2015) 2/6 ABBREVIATIONS NYHA: New York Heart Association; PH: Pulmonary Hypertension; RA: Right Atrium; SVV: Stroke Volume Variability; TEE: Trans Esophageal Echocardiography; MAC: Minimal Alveolar Concentration; NO: Nitric Oxide; cAMP: Cyclic Adenosine Mono Phosphate