台大医院09-07月模拟口试一：pulmonary hypertension
请陈述pulmonary hypertension的定义及如何评估严重度。在麻醉及手术之前，病人应接受哪些检查？作哪些准备？
试述麻醉中所要达成的physiological considerations？及你对Neuroaxial anesthesia和general anesthesia之看法。
参考答案
PH: mPAP>25 mmHg at rest or > 30 mmHg at axercise, PVR > 300 dynes.sec. cm-5
Severe PH: mPAP>60 mmHg, PVR > 600 dynes.sec. cm-5 ,RV failure
Preparation:
Examination: ECG, CXR, ABG, Echocardiogram…
With RV dysfunction: re-evaluate the need of surgery
For decrease PVR: Oxygen administration, bronchodilator, antibiotics, steroids, vasodilators ( with or without prostacyclin or trepostinil infusion)
For RV failure: inotropics
Physiological consideration and anesthetic goals
Preload: maintain
SVR: maintain for avoiding hypotension
Contractility: maintain normal to high
HR: sinus rhythm, avoid bradycardia
Avoid myocardial ischemia
PVR: not increase
Avoid hypotension
Neuroaxial anesthesia:
Nerve block: OK
Spinal anesthesia: Hypotension?
Epidural:
General anesthesia
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