Center for Advanced Lung Disease and Lung Transplant, University of South Florida - Tampa General Hospital, Tampa, FL, USA.
Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France.
Eur Respir Rev. 2021 Dec 22;30(162). doi: 10.1183/16000617.0166-2021. Print 2021 Dec 31.
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.
肺动脉高压（PH）给围手术期护理带来了重大挑战。它与大量的发病率和死亡率相关。在过去的十年中，已经出现了大量关于 PH 患者管理的信息。然而，仍然缺乏信息来指导这些患者的围手术期评估和管理。然而，通过关注复杂疾病的精心设计的疾病适应麻醉管理，并采用多学科方法，实现满意的结果是可行的。PH 患者围手术期管理的基石是保护右心室（RV）功能，关注维持 RV 前负荷、收缩力，并在患者围手术期护理的每个阶段限制 RV 后负荷的增加。在这方面，麻醉前评估、麻醉药物的选择、适当的液体管理、适当的通气、纠正缺氧、高碳酸血症、酸碱平衡和疼痛控制至关重要。本质上，PH 患者的围手术期管理是复杂和多方面的。不幸的是，缺乏全面的循证指南来指导我们完成这个复杂的过程。我们对 PH 患者进行了文献回顾，重点是围手术期评估，并为这些患者在非心脏、非产科手术期间提出了管理算法。
