Anesthetic considerations for a parturient with pulmonary hypertension

Anesthetic Management of a Pregnant Female with Interstitial Lung Disease and Pulmonary Hypertension for Emergency Lower Segment Cesarean Section

“…Invasive blood pressure monitoring is indicated in severe pulmonary hypertensive patients undergoing surgery with major fluid shifts. [1] We avoided general anesthesia in our patient to avoid undue risk of pulmonary aspiration, rapid changes of systemic and pulmonary vascular resistance with a rapid sequence intubation. Positive pressure ventilation may decrease venous return and increase pulmonary vascular resistance.…”

“…Positive pressure ventilation may decrease venous return and increase pulmonary vascular resistance. [1] Goal of anesthesia management include maintenance of preload, systemic vascular resistance, contractility to maintain cardiac output and to prevent rise in pulmonary vascular resistance (hypoxia, hypercarbia, hypothermia, academia, pain).Systemic hypotension may also increase the degree of shunting and worsen hypoxia. [1] We chose for CSE in our patient so as to avoid the unwanted effects of GA in our patient, and although central neuraxial blockade has been used safely in patients with PH, blocking cardiac sympathetic fibers in the upper thoracic region disrupts right ventricular regulation and can be detrimental in parturient with pulmonary hypertension [1].Tight hemodynamic monitoring and control is of utmost importance.…”

“…majority of deaths occur in the first month of delivery, therefore clinical observation is mandatory. [1] Multimodal analgesia should be the norm in the immediate post-operative period and the same was provided via epidural analgesia and TAP blockade.…”

Management of Severe Scoliosis with Pulmonary Arterial Hypertension: A Single-Center Retrospective Case Series Study

“…Patients with PAH are unable to accommodate alterations in right ventricular (RV) preload or afterload induced by fluid shifts, medications, or changes in the autonomic nervous system precipitated by hypoxia or hypercapnia. 8 These factors become magnified in situations of added stress such as surgical intervention. Systemic hypotension and arrhythmias may precipitate RV ischemia, further worsening RV function.…”

“…[11][12][13] Close monitoring, optimization of systemic blood pressure (BP), pain control, oxygenation and ventilation, avoidance of exacerbating factors, and use of vasopressors and pulmonary vasodilators as necessary are essential elements of management. 8,12,14 Understanding the pathophysiology, cause, and severity of PAH in the individual perioperative patient allows accurate risk assessment, optimization of PAH and RV function prior to surgery, and appropriate intraoperative and postoperative management. 2,15,16 Appropriate preoperative evaluation and medical optimization, as well as close monitoring during the perioperative period to avoid noxious stimuli, are essential for success.…”