Perioperative Decision-Making in Pulmonary Hypertension
Ajay Kumar Jha1, Nivedita Jha2, Vishwas Malik3
1Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
Heart, Lung & Circulation
|February 25, 2023
Summary
Pulmonary hypertension (PH) poses significant perioperative risks. This review outlines strategies for anesthetic and surgical management of PH patients undergoing non-cardiac surgery.
Area of Science:
- Anesthesiology
- Cardiology
- Pulmonology
Background:
- Pulmonary hypertension (PH) is a hemodynamic condition linked to various pathologies, often requiring perioperative evaluation.
- PH significantly increases risks for morbidity and mortality in patients undergoing intermediate- to high-risk non-cardiac surgery.
- Current guidelines inadequately address the importance of PH in perioperative decision-making and outcomes.
Purpose of the Study:
- To review anesthetic and surgical challenges in patients with PH.
- To propose a preoperative evaluation plan for PH patients.
- To guide surgical and anesthetic decision-making and management.
Main Methods:
- This is a narrative review of existing literature.
- Focuses on understanding PH pathophysiology and its perioperative implications.
- Synthesizes evidence for risk assessment and management strategies.
Main Results:
- PH is increasingly recognized in perioperative settings, particularly with echocardiography use.
- Preoperative evaluation must consider surgery type, invasiveness, and duration.
- Anesthetic and surgical decisions require understanding complex cardiopulmonary interactions in PH patients.
Conclusions:
- Effective perioperative management of PH necessitates a comprehensive approach.
- Preoperative risk stratification, tailored anesthetic plans, and vigilant monitoring are crucial.
- Further integration of PH considerations into surgical guidelines is warranted.
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