Perioperative management of patients with pulmonary hypertension undergoing non-cardiothoracic, non-obstetric surgery: a systematic review and expert consensus statement
Autor: | Colm McCabe, Anna Reed, Susanna Price, Aimee Brame, Benjamin Garfield, Robin Condliffe, Thomas Pickworth, Luke Howard, David M. Alexander, Sean Gaine, TC Aw, Guillermo Martinez, S. Kemp, Benjamin E. Schreiber, Davina Wong, Denny Z. H. Levett, Chinthaka B Samaranayake, Carl Harries, Martin Johnson, Dolores Taboada, Bhashkar Mukherjee, David G. Kiely, Gerry Coghlan, Philip Marino, Stephen J. Wort, Laura C. Price, James L. Lordan, Konstantinos Dimopoulos, Stephane Ledot, Colin Church, Rachel J. Davies, Aleksander Kempny, Michael A. Gatzoulis, Andrew Curry |
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Rok vydání: | 2020 |
Předmět: |
medicine.medical_specialty
Consensus Sedation Hypertension Pulmonary Perioperative Care 03 medical and health sciences 0302 clinical medicine Postoperative Complications 030202 anesthesiology medicine Humans Decompensation Expert Testimony medicine.diagnostic_test business.industry Perioperative medicine.disease Pulmonary hypertension Endoscopy Surgery Anesthesiology and Pain Medicine Systematic review medicine.anatomical_structure Vascular resistance medicine.symptom Risk assessment business |
Zdroj: | British journal of anaesthesia. 126(4) |
ISSN: | 1471-6771 |
Popis: | Background The risk of complications, including death, is substantially increased in patients with pulmonary hypertension (PH) undergoing anaesthesia for surgical procedures, especially in those with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH). Sedation also poses a risk to patients with PH. Physiological changes including tachycardia, hypotension, fluid shifts, and an increase in pulmonary vascular resistance (PH crisis) can precipitate acute right ventricular decompensation and death. Methods A systematic literature review was performed of studies in patients with PH undergoing non-cardiac and non-obstetric surgery. The management of patients with PH requiring sedation for endoscopy was also reviewed. Using a framework of relevant clinical questions, we review the available evidence guiding operative risk, risk assessment, preoperative optimisation, and perioperative management, and identifying areas for future research. Results Reported 30 day mortality after non-cardiac and non-obstetric surgery ranges between 2% and 18% in patients with PH undergoing elective procedures, and increases to 15–50% for emergency surgery, with complications and death usually relating to acute right ventricular failure. Risk factors for mortality include procedure-specific and patient-related factors, especially markers of PH severity (e.g. pulmonary haemodynamics, poor exercise performance, and right ventricular dysfunction). Most studies highlight the importance of individualised preoperative risk assessment and optimisation and advanced perioperative planning. Conclusions With an increasing number of patients requiring surgery in specialist and non-specialist PH centres, a systematic, evidence-based, multidisciplinary approach is required to minimise complications. Adequate risk stratification and a tailored-individualised perioperative plan is paramount. |
Databáze: | OpenAIRE |
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