Anesthetic Management for Lobectomy in a Patient with Pulmonary Arterial Hypertension

Pulmonary arterial hypertension (PAH) is a known risk factor of perioperative complications, but the risks for non-cardiac operations have not yet been examined sufficiently. We report a case of a right lower lobectomy in a patient with PAH. A 73-year-old woman with Sjögren's syndrome was sched...

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Published inMasui. The Japanese journal of anesthesiology Vol. 65; no. 2; p. 139
Main Authors Imajo, Yukihiro, Komasawa, Nobuyasu, Kusaka, Yusuke, Kido, Haruki, Minami, Toshiaki
Format Journal Article
LanguageJapanese
Published Japan 01.02.2016
Subjects
Aged
Anesthesia - methods
Dexmedetomidine - therapeutic use
Female
Fentanyl - administration & dosage
Humans
Hypertension, Pulmonary - drug therapy
Hypertension, Pulmonary - physiopathology
Lung Neoplasms - surgery
Phenylpropionates - therapeutic use
Pneumonectomy - methods
Propofol - administration & dosage
Pyridazines - therapeutic use
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Summary:Pulmonary arterial hypertension (PAH) is a known risk factor of perioperative complications, but the risks for non-cardiac operations have not yet been examined sufficiently. We report a case of a right lower lobectomy in a patient with PAH. A 73-year-old woman with Sjögren's syndrome was scheduled for right lowr lobectomy for primary lung cancer under general anesthesia. She was diagnosed with symptomatic PAH (estimated mean pulmonary arterial pressure, 40 mmHg) and medicated with ambrisentan. After induction of general anesthesia with propofol and fentanyl, a pulmonary artery catheter was placed to measure pulmonary artery pressure. The Pp/Ps was roughly 0.4 and the pulmonary artery clamp elevated it to 0.5. Milrinone administration gradually improved the Pp/Ps to 0.3. To avoid pulmonary artery pressure elevation during emergence of anesthesia, continuous dexmedetomidine was administered. The double-lumen tracheal tube was extubated uneventfully with minimal elevation in pulmonary arterial pressure.
ISSN:0021-4892