| Anaesthesia and right ventricular failure. | |
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MedLine Citation:
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PMID: 19499856 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Acute right ventricular (RV) failure has until recently received relatively little attention in the cardiology, critical care or anaesthesia literature. However, it is frequently encountered in cardiac surgical cases and is a significant cause of mortality in patients with severe pulmonary hypertension who undergo non-cardiac surgery. RV dysfunction may be primarily due to impaired RV contractility, or volume or pressure overload. In these patients, an increased pulmonary vascular resistance (PVR) or a decreased aortic root pressure may lead to RV ischaemia, resulting in a rapid, downward haemodynamic spiral. The key aspects of 'RV protection' in patients who are at risk of perioperative decompensation are prevention, detection and treatment aimed at reversing the underlying pathophysiology. Minimising PVR and maintaining systemic blood pressure are of central importance in the prevention of RV decompensation, which is characterised by a rising central venous pressure and a falling cardiac output. Although there are no outcome data to support any therapeutic strategy for RV failure when PVR is elevated, the combination of inhaled iloprost or intravenous milrinone with oral sildenafil produces a synergistic reduction in PVR, while sparing systemic vascular resistance. Levosimendan is a promising new inotrope for the treatment of RV failure, although its role in comparison to older agents such as dobutamine, adrenaline and milrinone has yet to be determined. This is also the case for the use of vasopressin as an alternative pressor to noradrenaline. If all else has failed, mechanical support of the RV should be considered in selected cases. |
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Authors:
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P Forrest |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Anaesthesia and intensive care Volume: 37 ISSN: 0310-057X ISO Abbreviation: Anaesth Intensive Care Publication Date: 2009 May |
Date Detail:
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Created Date: 2009-06-08 Completed Date: 2009-06-30 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0342017 Medline TA: Anaesth Intensive Care Country: Australia |
Other Details:
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Languages: eng Pagination: 370-85 Citation Subset: IM |
Affiliation:
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Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Anesthetics
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administration & dosage*,
adverse effects Blood Pressure Cardiac Output Cardiotonic Agents / pharmacology, therapeutic use Heart Failure / etiology, mortality, physiopathology*, therapy Humans Hypertension, Pulmonary / complications Intraoperative Complications / prevention & control Perioperative Care / methods* Risk Factors |
| Chemical | |
Reg. No./Substance:
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0/Anesthetics; 0/Cardiotonic Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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