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