Anaes SAQs · Thoracic anaesthesia
Pulmonary hypertension and COPD in thoracic anaesthesia
Final-examination SAQ for pulmonary-hypertension-copd-thoracic.
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ANZCAFRCAEDAICABAFCAI
Prompt
A patient with group 3 PH secondary to severe COPD needs VATS lobectomy. Detail haemodynamic goals, ventilation strategy, and management of acute RV failure on OLV.
Model answer
Goals (4). Maintain O2, avoid acidosis/hypercapnia, preserve SVR, continue PH meds.
[1]Vent/OLV (5). Protective VT, limit Paw/auto-PEEP, bronchodilators, early hypoxaemia algorithm, low threshold for two-lung.
[2] [3]RV failure (6). 100% O2, fix CO2/acid, reduce Paw, noradrenaline ± vasopressin, RV inotrope, inhaled vasodilator if available.
[1]References3ShowHide
- [1]Minai OA et al. Perioperative risk and management in patients with pulmonary hypertension. Chest, 2013.PMID 23880683
- [2]Brassard CL et al. Step-by-step clinical management of one-lung ventilation: continuing professional development. Canadian Journal of Anesthesia, 2014.PMID 25389025
- [3]Karzai W, Schwarzkopf K. Hypoxemia during one-lung ventilation: prediction, prevention, and treatment. Anesthesiology, 2009.PMID 19417615