Li Qiang, Zeng Fei, Chen Tao, Liang Mengqiu, Lei Xue, Liang Yijian, Zheng Chuandong, Huang He
Department of Anesthesiology, The Third People's Hospital of Chengdu, Southwest Jiao Tong University, Chengdu, China.
Department of Anesthesiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Geriatr Orthop Surg Rehabil. 2022 Mar 19;13:21514593221080279. doi: 10.1177/21514593221080279. eCollection 2022.
To determine the impact of anesthesia encountered and to optimize the treatment of perioperative pulmonary arterial hypertension (PAH) in an effort to improve perioperative management and reduce complications.
We conducted a retrospective analysis of scoliosis patients with PAH who underwent scoliosis surgery.
During this period, we identified a total of 22 patients. Their mean age was 22.18 ± 2.11 years. 16 PAH patients (72.72%) received PAH-specific treatment. Only Propofol-based TIVA was used intraoperatively. During the procedure, pulmonary artery catheters and PICCO catheters were placed in all patients to monitor intraoperative and postoperative mPAP, MAP, PRVI and SRVI. During tracheal intubation and intraoperative awake testing, mPAP generally tended to increase in all patients. 6 patients (27.27%) received intraoperative PAH-Specific therapy. All patients received oral sildenafil (75-100 mg/d orally), and 9 patients received postoperative oral sildenafil combined with nebulized iloprost (20 μg/d); intravenous treprostinil (2 ng/kg/min started and titrated to 10-17.5 ng/kg/min); or bosentan (250 mg/d) postoperatively. 7 patients (31.82%) reported postoperative complications, including 2 cases of respiratory failure requiring reintubation, 1 case of right heart failure, 2 cases of superficial surgical site infection, 1 case of fluid and electrolyte and acid-base imbalances, 2 cases of pneumonia and 1 case of pulmonary oedema with fluid overload. Two patients developed more than 1 postoperative complication. No in-hospital death occurred.
The anesthetic management of scoliosis patients with PAH is important task that, like its own surgery, relies on the input of the multidisciplinary team for its success. Close monitoring, optimization of systemic blood pressure, pain control, oxygenation and ventilation, avoidance of exacerbating factors, and the use of vasopressors and pulmonary vasodilators when necessary are essential elements of management.
确定所遇到的麻醉影响，并优化围手术期肺动脉高压（PAH）的治疗，以改善围手术期管理并减少并发症。
我们对接受脊柱侧弯手术的PAH脊柱侧弯患者进行了回顾性分析。
在此期间，我们共确定了22例患者。他们的平均年龄为22.18±2.11岁。16例PAH患者（72.72%）接受了PAH特异性治疗。术中仅使用了基于丙泊酚的全凭静脉麻醉。在此过程中，所有患者均放置了肺动脉导管和脉搏指示连续心输出量（PICCO）导管，以监测术中和术后的平均肺动脉压（mPAP）、平均动脉压（MAP）、外周血管阻力指数（PRVI）和全心舒张末期容积指数（SRVI）。在气管插管和术中清醒测试期间，所有患者的mPAP总体上趋于升高。6例患者（27.27%）接受了术中PAH特异性治疗。所有患者术后均口服西地那非（75 - 100mg/d），9例患者术后口服西地那非并联合雾化吸入伊洛前列素（20μg/d）；静脉注射曲前列尼尔（起始剂量为2ng/kg/min，滴定至10 - 17.5ng/kg/min）；或波生坦（250mg/d）。7例患者（31.82%）报告了术后并发症，包括2例呼吸衰竭需要再次插管、1例右心衰竭、2例手术浅表部位感染、1例液体和电解质及酸碱失衡、2例肺炎和1例因液体超负荷导致的肺水肿。2例患者出现了不止1种术后并发症。无院内死亡发生。
PAH脊柱侧弯患者的麻醉管理是一项重要任务，如同手术本身一样，其成功依赖于多学科团队的投入。密切监测、优化全身血压、控制疼痛、氧合和通气、避免加重因素以及在必要时使用血管升压药和肺血管扩张剂是管理的关键要素。
