title: The Post-Anesthetic Care of Pediatric Patients With Pulmonary Hypertension.
abstract: Few conditions make even the most experienced pediatric anesthesiologists take pause. Pulmonary hypertension is one such condition due to the associated high perioperative morbidity and mortality. Much is written about the intraoperative management of pediatric pulmonary hypertension. This article will instead focus on postoperative care and review the evidence in support of a risk stratification approach for the post-anesthetic disposition of these patients. The total risk for post-anesthetic adverse events includes the patient's baseline risk factors and the incremental risks imposed by the procedure and anesthetic. A proposal with recommendations to guide practitioners and a table summarizing relevant factors are provided. Last, the readers' attention is drawn to the heterogeneity of pulmonary hypertensive disease. Pulmonary arterial hypertension (precapillary) differs significantly from pulmonary venous hypertension (postcapillary); the anesthetic management for one may be relatively contraindicated in the other. Their dissimilarities justify the need to distinguish them for study and research endeavors.
authors.affiliation: Eastern Virginia Medical School, Norfolk, VA, USA Children's Hospital of the King's Daughters, Norfolk, VA, USA dchau4g@yahoo.com.
authors.forename: Destiny F
authors.initials: DF
authors.lastname: Chau
authors.affiliation: University of Texas Medical Branch at Galveston, TX, USA Driscoll Children's Hospital, Corpus Christi, TX, USA.
authors.forename: Meera
authors.initials: M
authors.lastname: Gangadharan
authors.affiliation: Eastern Virginia Medical School, Norfolk, VA, USA Children's Hospital of the King's Daughters, Norfolk, VA, USA.
authors.forename: Lopa P
authors.initials: LP
authors.lastname: Hartke
authors.affiliation: Children's Hospital Colorado, Aurora, CO, USA University of Colorado, Denver, Aurora, CO, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Twite
mesh_terms: D000758:Anesthesia; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality / Q000628:therapy*; D007223:Infant; D007231:Infant, Newborn; D059035:Perioperative Period / Q000401:mortality; D011182:Postoperative Care / Q000379:methods*
keywords: cardiac anesthesia; children; hypertension; pediatric intensive care; perioperative mortality; postoperative care; postoperative complications; pulmonary artery pressure