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Chapter 40 - Idiopathic Pulmonary Hypertension

from Section 7 - Miscellaneous Lesions and Syndromes

Published online by Cambridge University Press:  09 September 2021

Laura K. Berenstain
Affiliation:
Cincinnati Children's Hospital Medical Center
James P. Spaeth
Affiliation:
Cincinnati Children's Hospital Medical Center
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Summary

Idiopathic pulmonary arterial hypertension is a subset of pulmonary hypertension in which progressive narrowing of pulmonary vasculature leads to an increase in pulmonary vascular resistance and eventual right ventricular failure. Survival and quality of life have significantly improved with the advent of targeted therapies that promote pulmonary vasodilation and improve right ventricular function. Children with pulmonary hypertension have a 20-fold higher incidence of perioperative cardiac arrest compared to the general pediatric population. A well-balanced, hemodynamically stable anesthetic that aims to avoid increases in pulmonary vascular resistance and decreases in ventricular function or coronary perfusion is crucial in preventing a pulmonary hypertensive crisis. The anesthetist must anticipate, rapidly recognize, and treat impending signs of pulmonary hypertensive crisis in order to safely anesthetize a child with pulmonary hypertension.

Type
Chapter
Information
Congenital Cardiac Anesthesia
A Case-based Approach
, pp. 305 - 313
Publisher: Cambridge University Press
Print publication year: 2021

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References

Suggested Reading

Abman, S. H., Hansmann, G., and Archer, S. L. Pediatric pulmonary hypertension: Guidelines from the American Heart Association and American Thoracic Society. Circulation 2015; 132: 2037–99.CrossRefGoogle ScholarPubMed
Friesen, R. H., Nichols, C. S., Twite, M. D., et al. The hemodynamic response to dexmedetomidine loading dose in children with and without pulmonary hypertension. Anesth Analg 2013; 117: 953–9.CrossRefGoogle ScholarPubMed
Friesen, R. H. and Williams, G. D. Anesthetic management of children with pulmonary arterial hypertension. Pediatr Anesth 2008; 18: 208–16. DOI: 10.1111/j.1460-9592.2008.02419.x.CrossRefGoogle ScholarPubMed
Galie, N. and Simonneau, G. The Fifth World Symposium on Pulmonary Hypertension. J Am Coll Cardiol 2013; 62: D1D3.CrossRefGoogle ScholarPubMed
Latham, G. J. and Yung, D. Current understanding and perioperative management of pediatric pulmonary hypertension. Pediatr Anesth 2019; 29: 441–56. DOI: 10.1111/pan.13542.Google Scholar
Nathan, A. T., Nicolson, S. C., and McGowan, F. X. A word of caution: dexmedetomidine and pulmonary hypertension. Anesth Analg 2014; 119: 216–17.Google Scholar
Shah, S. and Szmuszkovicz, J. R. Pediatric perioperative pulmonary arterial hypertension: a case-based primer. Children 2017; 4: 92. DOI: 10.3390/children4100092.CrossRefGoogle ScholarPubMed
Twite, M. D. and Friesen, R. H. Anesthesia for pulmonary hypertension. In Andropoulos, D. B., Stayer, S., Mossad, E. B., et al. eds., Anesthesia for Congenital Heart Disease, 3rd ed. Hoboken, NJ: John Wiley & Sons, 2015; 661–76.Google Scholar

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