Pulmonary Hypertensive Crisis on Induction of Anesthesia

Anesthesia for lung transplantation remains one of the highest risk surgeries in the domain of the cardiothoracic anesthesiologist. End-stage lung disease, pulmonary hypertension, and right heart dysfunction as well as other comorbid disease factors predispose the patient to cardiovascular, respirat...

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Bibliographic Details
Published in:Seminars in cardiothoracic and vascular anesthesia 2017-03, Vol.21 (1), p.105-113
Main Authors: Schisler, Travis, Marquez, Jose M, Hilmi, Ibtesam, Subramaniam, Kathirvel
Format: Article
Language:English
Subjects:
Adrenergic alpha-Agonists - therapeutic use
Anesthesia
Bronchodilator Agents - therapeutic use
Calcium Chloride - therapeutic use
Cardiopulmonary Resuscitation - methods
Cardiotonic Agents - therapeutic use
Epinephrine - therapeutic use
Fatal Outcome
Female
Heart Arrest - complications
Heart Arrest - physiopathology
Heart Arrest - therapy
Humans
Hypertension, Pulmonary - complications
Hypertension, Pulmonary - physiopathology
Hypertension, Pulmonary - therapy
Lung Transplantation
Male
Middle Aged
Milrinone - therapeutic use
Nitric Oxide - therapeutic use
Norepinephrine - therapeutic use
Sodium Bicarbonate - therapeutic use
Vasoconstrictor Agents - therapeutic use
Vasopressins - therapeutic use
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Summary:Anesthesia for lung transplantation remains one of the highest risk surgeries in the domain of the cardiothoracic anesthesiologist. End-stage lung disease, pulmonary hypertension, and right heart dysfunction as well as other comorbid disease factors predispose the patient to cardiovascular, respiratory and metabolic dysfunction during general anesthesia. Perhaps the highest risk phase of surgery in the patient with severe pulmonary hypertension is during the induction of anesthesia when the removal of intrinsic sympathetic tone and onset of positive pressure ventilation can decompensate a severely compromised cardiovascular system. Severe hypotension, cardiac arrest, and death have been reported previously. Here we present 2 high-risk patients for lung transplantation, their anesthetic induction course, and outcomes. We offer suggestions for the safe management of anesthetic induction to mitigate against hemodynamic and respiratory complications.
ISSN:1940-5596
DOI:10.1177/1089253216652222