Anaes · Thoracic anaesthesia
Pulmonary hypertension and COPD in thoracic anaesthesia
Also known as Pulmonary hypertension anaesthesia · COPD thoracic surgery · Right ventricular failure · OLV in pulmonary hypertension
Perioperative management of pulmonary hypertension and COPD for thoracic surgery: RV physiology, haemodynamic goals, OLV risks, ventilation strategies, and crisis treatment of acute RV failure.
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Red flags
- Avoid increases in PVR: hypoxia, hypercapnia, acidosis, high airway pressures, pain, and hypothermia.
- Support RV coronary perfusion: maintain SVR; avoid pure systemic vasodilation.
- OLV may critically raise PVR and precipitate RV failure — have rescue plan.
- Continue chronic PH therapies perioperatively when possible with specialist input.
- COPD: optimise bronchodilators; protective ventilation; plan regional analgesia for cough.
Meet the patient
A 72-year-old with severe COPD and Group 3 pulmonary hypertension is listed for a right upper lobectomy. The echo shows a dilated RV with reduced TAPSE. She is on home oxygen at 2 L and her baseline SpO2 is 91 percent. The surgeon wants to know if you are happy to proceed.[1]
The question is not whether you can induce her — it is whether the RV will survive one-lung ventilation. The right ventricle in pulmonary hypertension lives one hypoxic, hypercapnic, high-airway-pressure minute from failure, and OLV is all three at once. Your whole plan exists to defend that RV.[3]
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 Can J Anaesth, 2014.PMID 25389025
- [3]Karzai W, Schwarzkopf K. Hypoxemia during one-lung ventilation: prediction, prevention, and treatment Anesthesiology, 2009.PMID 19417615