Title:Pulmonary Hypertension in the Perioperative Period-Focus on Current and Emerging Therapies
Volume: 9
Issue: 1
Author(s): Harish Ramakrishna
Affiliation:
Keywords:
Inotropes, nitric oxide, pulmonary hypertension, pulmonary vasodilators, right ventricular failure.
Abstract: Patients with pulmonary hypertension continue to present for both cardiac and non-cardiac surgery in
greater numbers worldwide, and are usually managed by cardiothoracic anesthesiologists. These specialists
have traditionally used intravenous therapy in the operating room to manipulate hemodynamics (cardiac output
systemic and pulmonary vascular resistance), to effectively manage these high risk patients. General anesthesia involves the
administration of both intravenous and inhaled drug therapy to achieve the desired goals, i.e. analgesia, amnesia, muscle relaxation
and blockade of autonomic activity. Anesthesiologists are the experts in the use and titration of drugs that are administered
through the inhaled route. However, this method of drug delivery presents many challenges, notably timing, dosage
accuracy, rapid titratability and consistency of drug delivery. In patients with severe pulmonary hypertension, arguably the
most rapid method of treating acutely reactive pulmonary vasculature would involve drugs that directly act upon the pulmonary
endothelium. In the perioperative period, pulmonary hypertension and right ventricular failure are high predictors of
morbidity and mortality and present significant challenges to the anesthesiologist. In this article, we will focus on the current
status of intravenous and inhaled therapy of these conditions, including concerned recent patents.
