Anaesthesia in Patients with Pulmonary Hypertension.

[Anaesthesia in Patients with Pulmonary Hypertension]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2019 May;54(5):334-346 Authors: Hötzel A, Loop T Abstract The perioperative management of patients with pulmonary hypertension requires an in-depth knowledge of the underlying disease, its related pathophysiology, effects of anaesthesia and surgery, as well as the appropriate pharmacotherapy. With respect to preoperative assessment, it is essential to review all available diagnostic findings, evaluate the patient's physical state, and to plan the anaesthetic procedure. Intraoperatively, the prevention of increases in pulmonary resistance and right ventricular decompensation appears essential. For this purpose, stress, hypothermia, decreased systemic perfusion, hypercapnia, hypoxemia, acidosis, and invasive mechanical ventilation should be avoided. If the pulmonary artery pressure exacerbates, application of inhaled nitric oxide or prostacyclins (iloprost), phosphodiesterase-III-inhibitors (milrinone) and phosphodiesterase-V-inhibitors (sildenafil), reflect first-line treatment options. In order to support the right ventricle, inotropes (adrenalin, dobutamine, levosimendan) or inodilators (milrinone) increase its contractility. Dependent on severity of disease and the magnitude of surgical intervention, patients with pulmonary hypertension require a specific continuous monitoring as well as trained staff in the postoperative period. PMID: 31083...
Source: Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS - Category: Intensive Care Authors: Tags: Anasthesiol Intensivmed Notfallmed Schmerzther Source Type: research

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In performing pulmonary endarterectomy (PEA) for a patient with chronic thromboembolic pulmonary hypertension (CTEPH), we encountered methemoglobinemia that was unmasked by hypothermia while on cardiopulmonary bypass (CPB). The patient on dapsone therapy for antiphospholipid antibody syndrome had developed acquired methemoglobinemia that went undiagnosed because her cyanosis was believed to be due to CTEPH and the resulting ventilation-perfusion (V/Q) mismatch. Although pharmacological triggers for methemoglobin are well known, causation by hypothermia is not described. Monitoring saturation while on CPB was challenging be...
Source: A&A Case Reports - Category: Anesthesiology Tags: Case Report Source Type: research
Pulmonary thromboendarterectomy is the standard surgical treatment for chronic thromboembolic pulmonary hypertension (CTEPH) if the surgical risk is reasonable to tolerate a prolonged surgery. The centre and surgeon should also have adequate annual volume of cases to maintain competence. CTEPH may occur in about 4% of patients after an episode of acute pulmonary thromboembolism over a one year period. There are persons with CTEPH who do not have a distinct previous history of acute pulmonary embolism as well. Pulmonary thromboendarterectomy is a technically challenging procedure and hence the importance of operator’...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiac Surgery chronic thromboembolic pulmonary hypertension CTEPH Source Type: blogs
Journal of Perinatology, Published online: 30 August 2019; doi:10.1038/s41372-019-0442-6Echocardiographic prediction of severe pulmonary hypertension in neonates undergoing therapeutic hypothermia for hypoxic-ischemic encephalopathy
Source: Journal of Perinatology - Category: Perinatology & Neonatology Authors: Source Type: research
We present a challenging case of a full-term neonate with inotrope-resistant Escherichia coli septic shock, profound coagulopathy, hypoxic respiratory failure, and HIE requiring CH and venoarterial (VA) ECMO. We illustrate that family-centered decision-making, ECMO, primary team, and subspecialist support is critical to success. In addition, we share the strategic medical interventions concomitantly used with VA ECMO to aid in the survival of this high-risk infant such as continuous veno-venous hemofiltration with AN69 membrane for cytokine and fluid removal, prostaglandin use to relieve right ventricular strain in maligna...
Source: Journal of Extra-Corporeal Technology - Category: Cardiovascular & Thoracic Surgery Tags: J Extra Corpor Technol Source Type: research
Abstract RATIONALE: Asphyxiated neonates with hypoxic ischemic encephalopathy (HIE) are at risk of myocardial dysfunction, however, echocardiography studies are limited and little is known about the relationship between hemodynamics and brain injury. OBJECTIVE: To analyze the association between severity of myocardial dysfunction and adverse outcome as defined by the composite of death or abnormal magnetic resonance imaging. METHODS: Neonates with HIE undergoing therapeutic hypothermia were enrolled. Participants underwent echocardiography at 24h, 72h (before rewarming) and 96h (after rewarming). Cerebra...
Source: American Journal of Respiratory and Critical Care Medicine - Category: Respiratory Medicine Authors: Tags: Am J Respir Crit Care Med Source Type: research
Authors: Lee NH, Nam SK, Lee J, Jun YH Abstract Background: Preterm infants have difficulty maintaining body temperature after birth. However, clinical guidelines advocate that neonatal body temperature should be maintained at 36.5-37.5°C. Purpose: We aimed to investigate the incidence of admission hypothermia in very low birth weight (VLBW) infants and to determine the association of admission temperature with in-hospital mortality and morbidities. Methods: A cohort study using prospectively collected data involving 70 neonatal intensive care units (NICUs) that participate in the Korean neonatal networ...
Source: Korean Journal of Pediatrics - Category: Pediatrics Tags: Korean J Pediatr Source Type: research
Conclusions: Therapeutic hypothermia can be applied to patients with severe congenital heart disease and hypoxic-ischemic encephalopathy. Low-dose prostaglandin E1 infusions are safe for ductal maintenance during cooling, but cardiopulmonary adverse effects should be anticipated.
Source: Pediatric Critical Care Medicine - Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research
Conclusions: Hypothermia shifts oxygen-hemoglobin dissociation curve to the left resulting in lower PaO2 for pulse oximetry. Monitoring oxygenation with arterial blood gas uncorrected for body temperature and pulse oximetry may underestimate hypoxemia in hypoxic-ischemic encephalopathy infants during whole-body hypothermia, while end-tidal CO2 reliably correlates with temperature-corrected PaCO2.
Source: Pediatric Critical Care Medicine - Category: Pediatrics Tags: Neonatal Intensive Care Source Type: research
CONCLUSION: Low-cost devices are safe and effective alternatives for maintaining TH in low-resource settings with adequate monitoring. ABBREVIATIONS: DAMA, discharged against medical advice; DIC, disseminated intravascular coagulation; HELIX, Hypothermia for Encephalopathy in Low- and Middle-Income Countries Trial; HIE, hypoxic ischaemic encephalopathy; IP, ice packs; LMIC, low- and middle-income countries; NICHD, National Institute of Child Health and Human Development; PCM, phase changing; TH, therapeutic hypothermia (TH); TOBY, total body hypothermia for neonatal encephalopathy. PMID: 30109814 [PubMed - as supplied by publisher]
Source: Paediatrics and international child health - Category: Pediatrics Tags: Paediatr Int Child Health Source Type: research
Publication date: September 2018Source: Archives of Cardiovascular Diseases Supplements, Volume 10, Issues 3–4Author(s): Stéphanie Delange, Jean-Benoît Thambo, Zakaria Jalal, Jean-Baptiste Mouton, Xavier Iriart, Pierre-Emmanuel SéguélaBackgroundAfter congenital heart surgery, delayed sternal closure (DSC) can be used electively to aid in hemodynamic and respiratory stability in the initial postoperative period. Risk factors for DSC have been previously determined for neonates. The purpose of our study was to determine risk factors that may predict the need for DSC in children 
Source: Archives of Cardiovascular Diseases Supplements - Category: Cardiology Source Type: research
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