Key result
Multidisciplinary planning and targeted vasodilators mitigate perioperative pulmonary hypertensive crises and RV failure.
Why the study?
The perioperative period is an extremely tenuous time for pediatric patients with pulmonary arterial hypertension, requiring multidisciplinary preoperative planning, early identification of pulmonary hypertensive crises, and practical strategies for postoperative management.
Provides a practical, case-based clinical primer emphasizing multidisciplinary preoperative planning, trigger avoidance, and targeted hemodynamic support to prevent and manage life-threatening perioperative pulmonary hypertensive crises in children.
May inform perioperative strategies in children with pulmonary hypertension; leaves open the need for prospective validation.
The perioperative period is an extremely tenuous time for the pediatric patient with pulmonary arterial hypertension. This article will discuss a multidisciplinary approach to preoperative planning, the importance of early identification of pulmonary hypertensive crises, and practical strategies for postoperative management for this unique group of children.
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Shah et al. (2017) conducted a review in Pediatric pulmonary arterial hypertension (including idiopathic pulmonary arterial hypertension) in the perioperative period. Multidisciplinary perioperative management and acute crisis therapy (including 100% FiO2 oxygen, inhaled nitric oxide, prostacyclin analogs, sildenafil, milrinone, and vasopressors) was evaluated on Prevention and management of perioperative pulmonary hypertensive crises. Multidisciplinary preoperative planning, avoidance of vasoconstrictive triggers, and targeted pulmonary vasodilators with RV support are essential to mitigate perioperative pulmonary hypertensive crises.
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