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Anesthesiology Research and Practice
Volume 2012 (2012), Article ID 356982, 16 pages
http://dx.doi.org/10.1155/2012/356982
Review Article

Perioperative Anesthesiological Management of Patients with Pulmonary Hypertension

1Klinikum St. Georg gGmbH, Klinik für Anästhesiologie, Intensiv und Schmerztherapie, Delitzscher Straße 141, 04129 Leipzig, Germany
2Medical Clinic and Polyclinic I, Department of Pneumology, Universitätsklinikum Leipzig AöR, 04103 Leipzig, Germany
3Clinic for Anesthesiology and Critical Care Medicine, Martin Luther University of Halle-Wittenberg, 06120 Halle, Germany

Received 3 May 2012; Revised 2 August 2012; Accepted 16 August 2012

Academic Editor: Ronald G. Pearl

Copyright © 2012 Jochen Gille et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Pulmonary hypertension is a major reason for elevated perioperative morbidity and mortality, even in noncardiac surgical procedures. Patients should be thoroughly prepared for the intervention and allowed plenty of time for consideration. All specialty units involved in treatment should play a role in these preparations. After selecting each of the suitable individual anesthetic and surgical procedures, intraoperative 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 hypotonic blood circulation, intravenous vasodilators (milrinone, dobutamine, prostacyclin, Na-nitroprusside, and nitroglycerine) should be administered with the greatest care. A method of treating elevations in 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.