Key result
Inhaled vasodilators, including nitric oxide and alternatives like prostanoids and phosphodiesterase inhibitors, effectively reduce pulmonary artery pressure while avoiding systemic hypotension.
Inhaled vasodilators offer an effective strategy for reducing pulmonary artery pressure in perioperative pulmonary hypertension while minimizing systemic hypotension.
May support inhaled vasodilators for perioperative pulmonary hypertension; leaves open comparative RCTs on agents and outcomes.
Patients with pulmonary hypertension (PH) are at high risk for complications in the perioperative setting and often receive vasodilators to control elevated pulmonary artery pressure (PAP). Administration of vasodilators via inhalation is an effective strategy for reducing PAP while avoiding systemic side effects, chiefly hypotension. The prototypical inhaled pulmonary-specific vasodilator, nitric oxide (NO), has a proven track record but is expensive and cumbersome to implement. Alternatives to NO, including prostanoids (such as epoprostenol, iloprost, and treprostinil), NO-donating drugs (sodium nitroprusside, nitroglycerin, and nitrite), and phosphodiesterase inhibitors (milrinone, sildenafil) may be given via inhalation for the purpose of treating elevated PAP. This review will focus on the perioperative therapy of PH using inhaled vasodilators.
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Ramakrishna et al. (2015) conducted a review in Pulmonary hypertension in the perioperative setting. Inhaled vasodilators was evaluated. Inhaled vasodilators, including nitric oxide and alternatives like prostanoids and phosphodiesterase inhibitors, effectively reduce pulmonary artery pressure while avoiding systemic hypotension.
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