Document Detail


Pulmonary hypertension in thoracic surgical patients.
MedLine Citation:
PMID:  20019603     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: Literature about thoracic surgery in patients with pulmonary hypertension is scarce. Perceived high risk has appropriately discouraged any unnecessary operation. However, the medical therapy for pulmonary hypertension has made great advances during the last decade. It is likely that future advances in survival and possibly the need for diagnostic procedures will increase the anesthesiologist's exposure to such patients. Understanding the unique physiology as well as new therapeutic agents will facilitate safe care for these challenging patients.
RECENT FINDINGS: Since 1998, there have been three World Heath Organization symposiums on pulmonary hypertension. The most recent meeting in 2008 at Dana Point included revisions of the classification scheme and updates on new trials and therapies. New drugs have been utilized in cardiac, lung, or liver transplant operations to treat pulmonary hypertension. It is also recognized that one-lung ventilation presents unique problems for the patient with pulmonary hypertension. Inhalation use of the new pulmonary vasodilator drugs represents a new frontier for intraoperative pharmacology.
SUMMARY: Here, the various types of pulmonary hypertension, physiologic changes, and new drug therapies are reviewed. Clinical experience with patients with pulmonary hypertension undergoing both nonthoracic and thoracic procedures is also reviewed. By identifying potential problem areas and application of new pharmacology, an approach to the patient with pulmonary hypertension is synthesized.
Authors:
Alan F Ross; Kenichi Ueda
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Current opinion in anaesthesiology     Volume:  23     ISSN:  1473-6500     ISO Abbreviation:  Curr Opin Anaesthesiol     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2009-12-25     Completed Date:  2010-03-31     Revised Date:  2013-06-18    
Medline Journal Info:
Nlm Unique ID:  8813436     Medline TA:  Curr Opin Anaesthesiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  25-33     Citation Subset:  IM    
Affiliation:
Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA. alan-ross@uiowa.edu
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MeSH Terms
Descriptor/Qualifier:
Anesthesia, Inhalation / methods*
Antihypertensive Agents / therapeutic use*
Epoprostenol / therapeutic use*
Humans
Hypertension, Pulmonary / classification,  drug therapy*
Piperazines / therapeutic use
Purines / therapeutic use
Receptor, Endothelin A / antagonists & inhibitors
Receptor, Endothelin B / antagonists & inhibitors
Sulfonamides / therapeutic use
Sulfones / therapeutic use
Thoracic Surgical Procedures / methods*
Vasodilator Agents / therapeutic use
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 0/Piperazines; 0/Purines; 0/Receptor, Endothelin A; 0/Receptor, Endothelin B; 0/Sulfonamides; 0/Sulfones; 0/Vasodilator Agents; 35121-78-9/Epoprostenol; 3M7OB98Y7H/sildenafil; Q326023R30/bosentan

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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