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Perioperative approach to precapillary pulmonary hypertension in non-cardiac non-obstetric surgery

Pulmonary hypertension (PH) confers a significant challenge in perioperative care. It is associated with substantial morbidity and mortality. A considerable amount of information about management of patients with PH has emerged over the past decade. However, there is still a paucity of information t...

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Autores principales: Bandyopadhyay, Debabrata, Lai, Christopher, Pulido, Juan N., Restrepo-Jaramillo, Ricardo, Tonelli, Adriano R., Humbert, Marc
Formato: Online Artículo Texto
Lenguaje:English
Publicado: European Respiratory Society 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9489200/
https://www.ncbi.nlm.nih.gov/pubmed/34937705
http://dx.doi.org/10.1183/16000617.0166-2021
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author Bandyopadhyay, Debabrata
Lai, Christopher
Pulido, Juan N.
Restrepo-Jaramillo, Ricardo
Tonelli, Adriano R.
Humbert, Marc
author_facet Bandyopadhyay, Debabrata
Lai, Christopher
Pulido, Juan N.
Restrepo-Jaramillo, Ricardo
Tonelli, Adriano R.
Humbert, Marc
author_sort Bandyopadhyay, Debabrata
collection PubMed
description Pulmonary hypertension (PH) confers a significant challenge in perioperative care. It is associated with substantial morbidity and mortality. A considerable amount of information about management of patients with PH has emerged over the past decade. However, there is still a paucity of information to guide perioperative evaluation and management of these patients. Yet, a satisfactory outcome is feasible by focusing on elaborate disease-adapted anaesthetic management of this complex disease with a multidisciplinary approach. The cornerstone of the peri-anaesthetic management of patients with PH is preservation of right ventricular (RV) function with attention on maintaining RV preload, contractility and limiting increase in RV afterload at each stage of the patient's perioperative care. Pre-anaesthetic evaluation, choice of anaesthetic agents, proper fluid management, appropriate ventilation, correction of hypoxia, hypercarbia, acid–base balance and pain control are paramount in this regard. Essentially, the perioperative management of PH patients is intricate and multifaceted. Unfortunately, a comprehensive evidence-based guideline is lacking to navigate us through this complex process. We conducted a literature review on patients with PH with a focus on the perioperative evaluation and suggest management algorithms for these patients during non-cardiac, non-obstetric surgery.
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spelling pubmed-94892002022-11-14 Perioperative approach to precapillary pulmonary hypertension in non-cardiac non-obstetric surgery Bandyopadhyay, Debabrata Lai, Christopher Pulido, Juan N. Restrepo-Jaramillo, Ricardo Tonelli, Adriano R. Humbert, Marc Eur Respir Rev Reviews Pulmonary hypertension (PH) confers a significant challenge in perioperative care. It is associated with substantial morbidity and mortality. A considerable amount of information about management of patients with PH has emerged over the past decade. However, there is still a paucity of information to guide perioperative evaluation and management of these patients. Yet, a satisfactory outcome is feasible by focusing on elaborate disease-adapted anaesthetic management of this complex disease with a multidisciplinary approach. The cornerstone of the peri-anaesthetic management of patients with PH is preservation of right ventricular (RV) function with attention on maintaining RV preload, contractility and limiting increase in RV afterload at each stage of the patient's perioperative care. Pre-anaesthetic evaluation, choice of anaesthetic agents, proper fluid management, appropriate ventilation, correction of hypoxia, hypercarbia, acid–base balance and pain control are paramount in this regard. Essentially, the perioperative management of PH patients is intricate and multifaceted. Unfortunately, a comprehensive evidence-based guideline is lacking to navigate us through this complex process. We conducted a literature review on patients with PH with a focus on the perioperative evaluation and suggest management algorithms for these patients during non-cardiac, non-obstetric surgery. European Respiratory Society 2021-12-22 /pmc/articles/PMC9489200/ /pubmed/34937705 http://dx.doi.org/10.1183/16000617.0166-2021 Text en Copyright ©The authors 2021 https://creativecommons.org/licenses/by-nc/4.0/This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org (mailto:permissions@ersnet.org)
spellingShingle Reviews
Bandyopadhyay, Debabrata
Lai, Christopher
Pulido, Juan N.
Restrepo-Jaramillo, Ricardo
Tonelli, Adriano R.
Humbert, Marc
Perioperative approach to precapillary pulmonary hypertension in non-cardiac non-obstetric surgery
title Perioperative approach to precapillary pulmonary hypertension in non-cardiac non-obstetric surgery
title_full Perioperative approach to precapillary pulmonary hypertension in non-cardiac non-obstetric surgery
title_fullStr Perioperative approach to precapillary pulmonary hypertension in non-cardiac non-obstetric surgery
title_full_unstemmed Perioperative approach to precapillary pulmonary hypertension in non-cardiac non-obstetric surgery
title_short Perioperative approach to precapillary pulmonary hypertension in non-cardiac non-obstetric surgery
title_sort perioperative approach to precapillary pulmonary hypertension in non-cardiac non-obstetric surgery
topic Reviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9489200/
https://www.ncbi.nlm.nih.gov/pubmed/34937705
http://dx.doi.org/10.1183/16000617.0166-2021
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