title: Spectrum of postoperative complications in pulmonary hypertension and obesity hypoventilation syndrome.
abstract: OBJECTIVE
  The purpose of this review is to identify chronic pulmonary conditions which may often not be recognized preoperatively especially before elective noncardiac surgery and which carry the highest risk of perioperative morbidity and mortality.
  
  
  RESULTS
  This review discusses some of the most recent studies that highlight the perioperative complications, and their prevention and management strategies.
  
  
  CONCLUSIONS
  Pulmonary hypertension is a well recognized risk factor for postoperative complications after cardiac surgery but the literature surrounding noncardiac surgery is sparse. Pulmonary hypertension was only recently classified as an independent risk factor for postoperative complications in the American Heart Association/American College of Cardiology Foundation Practice Guideline for noncardiac surgery. Spinal anesthesia should be avoided in most surgeries on patients with pulmonary hypertension because of it's rapid sympatholytic effects. The presence of significant right ventricle dysfunction and marked hypoxemia should prompt re-evaluation of the need for elective surgery. Obesity hypoventilation syndrome is even harder to recognize preoperatively as arterial blood gases are generally not obtained prior to elective noncardiac surgery. Amongst patients with obstructive sleep apnea this group of patients carries much higher risk of postoperative respiratory and congestive heart failure.
authors.affiliation: Departments of Hospital Medicine and Anesthesiology Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Roop K
authors.initials: RK
authors.lastname: Kaw
mesh_terms: D000775:Anesthesia, Spinal / Q000009:adverse effects; D002908:Chronic Disease; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications*; D000860:Hypoxia / Q000175:diagnosis / Q000209:etiology; D015994:Incidence; D010845:Obesity Hypoventilation Syndrome / Q000150:complications*; D018579:Patient Selection; D019990:Perioperative Care / Q000379:methods* / Q000592:standards; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D012307:Risk Factors; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000209:etiology