title: Update on anaesthetic approach to pulmonary hypertension.
abstract: Pulmonary hypertensive patients going for surgery are at significant risk of perioperative morbidity and mortality. They pose a clinically challenging situation for the anaesthetist and strategies to minimize the effects on these patients are discussed. Recent advances have allowed a better understanding of the pathophysiological mechanisms and development of new therapies. We present a framework for preoperative assessment and optimization. An update on the recent advances in medical therapy with calcium channel blockers, prostacyclin analogues, endothelin receptor antagonists and phosphodiesterase-5 inhibitors is provided and relevant anaesthetic concerns highlighted. Key strategies for intraoperative management are presented and we review the options and novel strategies for managing an acute episode of decompensated pulmonary hypertension intraoperatively. Promising new therapies being explored include intraoperative delivery of inhaled milrinone and inhaled prostacyclin analogues.
authors.affiliation: Department of Anaesthesia, Wythenshawe Hospital, Manchester, UK. teoyeewei@gmail.com
authors.forename: Yee Wei
authors.initials: YW
authors.lastname: Teo
authors.forename: Donna L
authors.initials: DL
authors.lastname: Greenhalgh
mesh_terms: D000758:Anesthesia / Q000379:methods*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002985:Clinical Protocols; D004541:Eisenmenger Complex / Q000209:etiology / Q000628:therapy; D065128:Endothelin Receptor Antagonists; D006801:Humans; D006976:Hypertension, Pulmonary / Q000145:classification / Q000628:therapy*; D016343:Monitoring, Intraoperative / Q000379:methods*; D019990:Perioperative Care / Q000379:methods*; D044062:Prostaglandins I / Q000627:therapeutic use; D018570:Risk Assessment
chemical_list: D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D065128:Endothelin Receptor Antagonists; D044062:Prostaglandins I