Treatment of pulmonary hypertension during surgery with nitric oxide and vasodilators.
OBJECTIVE
To describe the effects of the combination of several therapies on the pulmonary circulation and cardiac function in a patient with severe pulmonary hypertension.


METHODS
We report the case of a female patient with chronic secondary pulmonary hypertension and cardiac failure who underwent right hemicolectomy under general anesthesia. Insertion of a pulmonary artery catheter before the operation revealed pulmonary artery pressure (PAP) of 55/24 mm Hg which was lowered moderately by 40 parts per million (ppm) inhNO. During surgery, the patient presented an episode of atrial fibrillation with a slow, irregular heart rate of 45-50 min(-1) and variable systemic pressure. A dipyridamole DPD (0.2 mg x kg(-1)) bolus stabilized systemic pressure and increased heart rate and cardiac output. However, PAP did not change. Nitroglycerine infusion was started at 10 mg x hr(-1) shortly after the initiation of DPD. The patient responded favourably to combined inhNO, intravenous DPD and NTG therapy with a marked and sustained reduction of PAP and a systemic hemodynamic stability.


CONCLUSIONS
We conclude that: 1) in combination with inhNO, DPD does not augment the inhNO-induced decrease in PAP; 2) DPD improves the hemodynamic profile and elevates cardiac output; 3) therapeutic combination (inhaled NO, NTG, DPD) has a potent effect on pulmonary pressure in cardiac failure patients.
Jiang
Z Y
ZY
Département d'Anesthésie-Réanimation, Faculté de Médecine, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Québec, Canada.
Costachescu
T
T
Derouin
M
M
Blaise
G
G
D000280:Administration, Inhalation; D003082:Colectomy; D006152:Cyclic GMP / Q000502:physiology; D004176:Dipyridamole / Q000627:therapeutic use; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage*; D005996:Nitroglycerin / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents; D009569:Nitric Oxide; D004176:Dipyridamole; D005996:Nitroglycerin; D006152:Cyclic GMP