Pharmacological Management of Perioperative Pulmonary Hypertension: An Update

Henry Liu , Philip L. Kalarickal , Geoffrey L. Liu , Hong Yan , Charles J. Fox
Department of Anesthesiology, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, USA, Department of Anesthesiology, Emory University Hospital, Atlanta, USA, Department of Anesthesiology, LSUHSC-Shreveport, Shreveport, USA
J Anesth Perioper Med 2015; 2(6): 316- 324 . Published on Nov 28, 2015 . doi:10.24015/JAPM.2015.0042
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Aim of review: Pulmonary hypertension (PH) is a complex medical condition with various etiologies and different mechanisms for the pathogenesis. The diagnosis and management of PH has gone through a dramatic transformation process in the last two decades. Better understanding of the molecular pathogenesis of the condition has led to newer therapies which will potentially improve patient survival and overall well-being.

Method: This review discussed the current management modalities available for patients with PH.

Recent findings: The pharmacological management can be categorized into six major categories: 1). Targeting endothelin pathway (endothelin antagonists); 2). Targeting nitric oxide pathway (inhaled nitric oxide, phosphodiesterase [PDE] inhibitor); 3). Targeting prostaglandin pathway (prostacyclin agonists, thromboxane antagonists); 4). Targeting renin-angiotensin-aldosterone (RAA) pathway; 5). Targeting calcium channels; and 6). General support and other therapies. Commonly we use a combination of available drugs and means and individualize the regimen to each individual patient. Now patients with PH can enjoy a much longer lifespan and better quality of life.

Summary: For anesthesiologists, a thorough preoperative evaluation and accurate understanding of patient's status, a delicate intraoperative management and a multidisciplinary integrated postoperative treatment will safeguard our patients to undergo a smooth surgical procedure.



Citation: Henry Liu, Philip L. Kalarickal, Geoffrey L. Liu, Hong Yan, Charles J. Fox. Pharmacological management of perioperative pulmonary hypertension: an update. J Anesth Perioper Med 2015; 2: 316-24. doi: 10.24015/JAPM.2015.0042

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