Anesthetic and Circulatory Management of Patients with Pulmonary Hypertension

Abstract

Circulatory management of patients with pulmonary hypertension undergoing surgery is discussed in this paper. There are no vasodilators that specifically affect pulmonary circulation. Concomitant administration of vasoconstrictors is common. Effects of anesthetics on pulmonary circulation varies. Propofol and volatile anesthetics markedly depress right heart contractility. Nitrous oxide, thiopental and ketamine depress right heart contractility. Nitrous oxide markedly increases pulmonary vascular resistance（PVR）. Isoflurane and desflurane increase PVR. Sevoflurane and thiopental have no effect on PVR. Propofol decreases PVR. Ketamine increases PVR in adults, but it has no effect on PVR in children. Opioids have no effect on right heart contractility or PVR. Potential drug interactions between anesthetics and vasodilators should be considered. To prevent right heart failure, optimal preload and sustained sinus rhythm are important. Monitoring according to surgical risk is necessary. Dobutamine and phosphodiesterase 3 inhibitors are commonly used. Dopamine, noradrenaline and vasopressin may be used in patients with hypotension. Inhaled nitric oxide therapy is indicated restrictively in persistent pulmonary hypertension of the newborn and patients with PH after cardiac surgery in Japan. In high risk patients, a pulmonary hypertension referral center and team approach play important roles.