title: Perioperative management of pulmonary hypertension during lung transplantation (a lesson for other anaesthesia settings).
abstract: Patients with pulmonary hypertension are some of the most challenging for an anaesthesiologist to manage. Pulmonary hypertension in patients undergoing surgical procedures is associated with high morbidity and mortality due to right ventricular failure, arrhythmias and ischaemia leading to haemodynamic instability. Lung transplantation is the only therapeutic option for end-stage lung disease. Patients undergoing lung transplantation present a variety of challenges for anaesthesia team, but pulmonary hypertension remains the most important. The purpose of this article is to review the anaesthetic management of pulmonary hypertension during lung transplantation, with particular emphasis on the choice of anaesthesia, pulmonary vasodilator therapy, inotropic and vasopressor therapy, and the most recent intraoperative monitoring recommendations to optimize patient care.
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitario 12 de Octubre, Madrid, Spain. Electronic address: jmrabanal@humv.es.
authors.forename: J M
authors.initials: JM
authors.lastname: Rabanal
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: M I
authors.initials: MI
authors.lastname: Real
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Williams
mesh_terms: D000768:Anesthesia, General / Q000379:methods*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003250:Constriction; D019468:Disease Management; D004359:Drug Therapy, Combination; D015777:Eicosanoids / Q000627:therapeutic use; D015199:Extracorporeal Membrane Oxygenation; D006325:Heart Atria; D006439:Hemodynamics; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology; D007431:Intraoperative Complications / Q000188:drug therapy* / Q000503:physiopathology; D016040:Lung Transplantation; D016343:Monitoring, Intraoperative / Q000379:methods*; D020030:Nitric Oxide Donors / Q000627:therapeutic use; D061810:One-Lung Ventilation; D061646:Operative Time; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000188:drug therapy* / Q000503:physiopathology; D011229:Preanesthetic Medication; D011651:Pulmonary Artery; D011724:Pyridazines / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000379:methods; D000077464:Simendan; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D002316:Cardiotonic Agents; D015777:Eicosanoids; D006835:Hydrazones; D020030:Nitric Oxide Donors; D010726:Phosphodiesterase Inhibitors; D011724:Pyridazines; D014665:Vasodilator Agents; D000077464:Simendan
keywords: Anaesthesia; Anestesia; Disfunción ventrículo derecho; Hipertensión Pulmonar; Iloprost; Inhaled nitric oxide; Lung transplantation; Oxido nítrico inhalado; Pulmonary hypertension; Right ventricular dysfunction; Trasplante Pulmonar