Perioperative management of pulmonary vascular resistance

Abstract

Raised pulmonary vascular resistance, its sequelae of pulmonary hypertension and right-sided heart failure, presents the highest risk of morbidity and mortality during anaesthesia. Pulmonary vascular resistance (PVR) is increased by increases in the sympathetic output driven by stress-related perioperative circumstances such as hypothermia, pain, surgery-related inflammatory response and ventilation techniques. Additionally, several intraoperative factors such as fluid shifts, medications, systemic hypotension, arrhythmias,¹ hypoxaemia, hypercapnia, acidosis, hypervolaemia, and insufficient anaesthesia may exacerbate pulmonary hypertension.² These may precipitate acute right ventricular ischaemia and failure. Although it is important to understand the underlying pathology, this manuscript will address these very briefly, as the aim is to discuss the perioperative management of PVR.