Anesthetic Approach for Patients with Pulmonary Hypertension

General anesthesia remains the method of choice for major surgery. The marked reduction in contractility and dysrrhythmia that occur with halothane are poorly tolerated, isoflurane has less effect on contractility and may result in beneficial pulmonary vasodilatation, while nitrous oxide increase pulmonary resistance. Balanced technique limit the adverse effect of single one.Since general anesthesia has significant risks, limited regional anesthesia (e.g. axillary block for upper extremity and ankle block for foot surgery), and the use of neuraxial regional technique (spinal or epidural block) should be considered when appropriate. Thoracic epidural anesthesia has been reported to inhibit the native positive inotropic of the right ventricle to increased afterload and deteriorates the hemodynamic effects on acute pulmonary hypertensive patients.These patients have markedly increased morbidity and mortality during anesthesia and surgery, so survival correlates with the ability of the right ventricle to compensate for the increased PVR as assessed by cardiac output, right atrial pressure, and functional status. However, perioperative risk is also highly correlated with the surgical procedure.