title: Pulmonary Hypertensive Crisis on Induction of Anesthesia.
abstract: Anesthesia for lung transplantation remains one of the highest risk surgeries in the domain of the cardiothoracic anesthesiologist. End-stage lung disease, pulmonary hypertension, and right heart dysfunction as well as other comorbid disease factors predispose the patient to cardiovascular, respiratory and metabolic dysfunction during general anesthesia. Perhaps the highest risk phase of surgery in the patient with severe pulmonary hypertension is during the induction of anesthesia when the removal of intrinsic sympathetic tone and onset of positive pressure ventilation can decompensate a severely compromised cardiovascular system. Severe hypotension, cardiac arrest, and death have been reported previously. Here we present 2 high-risk patients for lung transplantation, their anesthetic induction course, and outcomes. We offer suggestions for the safe management of anesthetic induction to mitigate against hemodynamic and respiratory complications.
authors.affiliation: 1 University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA.
authors.forename: Travis
authors.initials: T
authors.lastname: Schisler
authors.affiliation: 1 University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Marquez
authors.affiliation: 1 University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA.
authors.forename: Ibtesam
authors.initials: I
authors.lastname: Hilmi
authors.affiliation: 1 University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA.
authors.forename: Kathirvel
authors.initials: K
authors.lastname: Subramaniam
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000758:Anesthesia; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002122:Calcium Chloride / Q000627:therapeutic use; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004837:Epinephrine / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000627:therapeutic use; D009569:Nitric Oxide / Q000627:therapeutic use; D009638:Norepinephrine / Q000627:therapeutic use; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014667:Vasopressins / Q000627:therapeutic use
chemical_list: D000316:Adrenergic alpha-Agonists; D001993:Bronchodilator Agents; D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D009569:Nitric Oxide; D017693:Sodium Bicarbonate; D020105:Milrinone; D002122:Calcium Chloride; D009638:Norepinephrine; D004837:Epinephrine
keywords: cardiac anesthesia; circulatory arrest; heart failure; pulmonary artery pressure; risk management; thoracic surgery