Pulmonary hypertension and noncardiac surgery: implications for the anesthesiologist

HE PERIOPERATIVE MANAGEMENT of patients with pulmonary hypertension (PH) is a growing concern for anesthesiologists worldwide as more patients with PH are presenting for elective noncardiac surgery. As a direct result of increased awareness and discovery of new medical therapies, patients with PH not only have a longer life expectancy, but also an improved quality of life. 1 Despite these recent advances, surgery still poses a significant risk for patients with PH. 2–5 A considerable amount of data already have been published showing increased mortality and morbidity in patients undergoing cardiac surgery with PH. 6–9 There are, however, much less data investigating the outcomes of patients with PH in the setting of noncardiac surgery. In a retrospective study by Ramakrishna et al, 42% of PH patients who underwent noncardiac surgery had 1 or more short-term morbid events, and 7% of patients had early death, which was due primarily to respiratory or right ventricular (RV) failure. 4 These outcomes have been compared to other high-risk populations undergoing noncardiac surgery such as elderly patients older than 80 years of age who experienced a mortality of 4.6%, 10 or those older than 65 years who experienced a mortality of 3.4%. 11 This review will discuss the classifications, pathophysiology, and the anesthetic management of patients with PH for noncardiac surgery.