Intraoperative Goal-Directed Anesthetic Management of the Patient with Severe Pulmonary Hypertension

Liu, Jinhong; Nahrwold, Daniel A.; Serdiuk, Andrew A.; Koontz, Dave B.; Fontaine, Jacques-Pierre

doi:10.12659/ajcr.916330

Cited by 3 publications

(9 citation statements)

References 17 publications

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“…Smulders et al reported that an elevated resting HR and reduced SV in 15 patients, 5 years after pneumonectomy [ 9 ]. Liu et al attempted to reduce the anesthetic and surgical risk associated with severe pulmonary hypertension by following the anesthetic management based on serial SV values using the FloTrac™ sensor [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Utility of the FloTrac™ Sensor for Anesthetic Management of Laparoscopic Surgery in a Patient After Pneumonectomy: A Case Report and Literature Review

et al. 2020

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Patient: Female, 35-year-old Final Diagnosis: Left adrenal gland metastases • post right pneumonectomy for lung metastases • retroperitoneal angiosarcoma Symptoms: Dyspnea Medication: — Clinical Procedure: FloTrac™ sensor Specialty: Anesthesiology Objective: Unusual setting of medical care Background: Pneumonectomy is associated with various anatomical changes and potential complications involving the respiratory and cardiovascular systems. How laparoscopic surgery affects cardiorespiratory status in postpneumonectomy patients is yet to be ascertained. Here, we describe the use of the FloTrac™ sensor for the anesthetic management of laparoscopic adrenalectomy in a postpneumonectomy patient. Case Report: A 35-year-old woman underwent an extended hysterectomy and right pneumonectomy for retroperitoneal angiosarcoma and lung metastases, respectively. The metastasis was found in her left adrenal gland; therefore, laparoscopic adrenalectomy was scheduled. Spirometry demonstrated the following: forced vital capacity (FVC), 1.90 L (55.6% of predicted value); vital capacity, 53.6%; forced expiratory volume (FEV 1 ), 1.38 L (47.3% of predicted value); and FEV 1 /FVC, 72.4%. The heart and mediastinal structures had shifted into the right hemithorax. Hugh-Jones classification was grade 2. The induction of general anesthesia was planned. The patient was orotracheally intubated and managed with the pressure control ventilation-volume guaranteed mode of ventilation, targeting an expired tidal volume of 6–7 ml/kg, without using PEEP. We evaluated cardiac output (CO), cardiac index (CI), stroke volume (SV), and stroke volume variation (SVV) using a FloTrac™ sensor. After the establishment of pneumoperitoneum, SVV increased. CO and SV decreased slightly; however, the patient’s hemodynamic status was stable. After surgery, we extubated the patient in the operating room; she demonstrated good progress and was discharged home on postoperative day 5. Conclusions: We found changes in the values of SVV after pneumoperitoneum in a postpneumonectomy patient. The FloTrac™ sensor may be a minimally invasive and promising monitor for detecting hemodynamic changes associated with laparoscopic surgery in postpneumonectomy patients.

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Section: Discussionmentioning

confidence: 99%

Utility of the FloTrac™ Sensor for Anesthetic Management of Laparoscopic Surgery in a Patient After Pneumonectomy: A Case Report and Literature Review

et al. 2020

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“…Positive pressure ventilation (PPV) is potentially hazardous when used in PAH patients. Lung-protective ventilation strategies involving low tidal volumes, adequate PEEP, and limiting peak inspiratory pressures should be employed to prevent the worsening of PAH and RV dysfunction [ 25 , 29 ].…”

Section: Reviewmentioning

confidence: 99%

“…Careful fluid administration guided by invasive hemodynamic monitoring and the use of diuretics when necessary is advised. Some authors propose that maintaining a slightly negative fluid balance could benefit these patients [ 25 , 29 ].…”

Section: Reviewmentioning

confidence: 99%

“…Therefore, they are particularly beneficial when appropriately employed in PAH patients. Intravenous agents, including propofol and etomidate, can be used for induction due to their minimal effects on PVR [ 25 , 29 ].…”

Section: Reviewmentioning

confidence: 99%

“…Neuromuscular blocking agents should be selected based on their cardiovascular effects. Cisatracurium and rocuronium are preferred due to their minimal impact on PVR [ 25 , 29 ].…”

Section: Reviewmentioning

confidence: 99%

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A Literature Review on the Anesthetic Management of Pulmonary Arterial Hypertension in Non-cardiothoracic Surgery

Hendrix¹

2023

Cureus

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Pulmonary hypertension (PH) is characterized by narrowing small pulmonary arteries, escalating pulmonary vascular resistance, and affecting the entire cardiovascular system. Pulmonary arterial hypertension (PAH) represents a subgroup of PH and typically affects one in 20,000 individuals. When treating individuals with PAH for non-cardiothoracic surgery, anesthetic management strategies should be tailored to the individual's specific needs. This literature review assessed the anesthetic management of PAH in non-cardiothoracic surgery. Electronic databases such as PubMed, ScienceDirect, Ovid Medical Literature Analysis and Retrieval System Online (MEDLINE), Cochrane, and Google Scholar were searched using relevant keywords related to PAH, noncardiac surgery, and anesthesia. Reference lists and author names were also investigated. The articles that met the inclusion criteria provided evidence suggesting that preoperative assessment should be comprehensive, hemodynamic goals should be established, anesthesia providers should be familiar with the underlying pathology, and cross-consultations between surgeons and anesthesia providers are essential for achieving satisfactory outcomes. Furthermore, patient care should extend beyond the surgical procedure into postoperative recovery in the post-anesthesia care unit (PACU) or intensive care unit (ICU) setting. In conclusion, it is vital for anesthetic management strategies to accommodate the unique needs of PAH patients to optimize their safety during perioperative care.

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Impact of staged goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing McKeown esophagectomy: a randomized controlled trial

Yang,

Shi,

Zhang

et al. 2024

BMC Anesthesiol

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Intraoperative Goal-Directed Anesthetic Management of the Patient with Severe Pulmonary Hypertension

Cited by 3 publications

References 17 publications

Utility of the FloTrac™ Sensor for Anesthetic Management of Laparoscopic Surgery in a Patient After Pneumonectomy: A Case Report and Literature Review

Utility of the FloTrac™ Sensor for Anesthetic Management of Laparoscopic Surgery in a Patient After Pneumonectomy: A Case Report and Literature Review

A Literature Review on the Anesthetic Management of Pulmonary Arterial Hypertension in Non-cardiothoracic Surgery

Impact of staged goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing McKeown esophagectomy: a randomized controlled trial

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