Perioperative management of patients with severe pulmonary hypertension in major orthopedic surgery: experience-based recommendations

Gille, Jochen; Sablotzki, Armin; Gerlach, Stefan; Malcharek, Michael J.; Gosse, A. Hope; Gahr, R. H.; Czeslick, Elke

doi:10.3205/iprs000062

Cited by 8 publications

(3 citation statements)

References 42 publications

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“…Studies evaluating the risks of PH in patients undergoing noncardiac surgery are presented in Table 2. 4,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] In a study of 17 million hospitalizations for major noncardiac surgery in the United States from 2004 to 2014, perioperative major adverse cardiovascular events, including death, myocardial infarction, or stroke, were 4-fold higher in patients with a diagnosis of PH compared with those without PH (8.3% versus 2.0%; P<0.001). 4 Patients with PH were older, less likely to be women, and more likely to have a history of smoking, chronic pulmonary disease, obstructive sleep apnea, and valvular heart disease than those without PH.…”

Section: Perioperative Risk Of Ph In Noncardiac Surgerymentioning

confidence: 99%

Evaluation and Management of Pulmonary Hypertension in Noncardiac Surgery: A Scientific Statement From the American Heart Association

Rajagopal¹,

Ruetzler²,

Ghadimi³

et al. 2023

Circulation

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Pulmonary hypertension, defined as an elevation in blood pressure in the pulmonary arteries, is associated with an increased risk of death. The prevalence of pulmonary hypertension is increasing, with an aging population, a rising prevalence of heart and lung disease, and improved pulmonary hypertension survival with targeted therapies. Patients with pulmonary hypertension frequently require noncardiac surgery, although pulmonary hypertension is associated with excess perioperative morbidity and death. This scientific statement provides guidance on the evaluation and management of pulmonary hypertension in patients undergoing noncardiac surgery. We advocate for a multistep process focused on (1) classification of pulmonary hypertension group to define the underlying pathology; (2) preoperative risk assessment that will guide surgical decision-making; (3) pulmonary hypertension optimization before surgery to reduce perioperative risk; (4) intraoperative management of pulmonary hypertension to avoid right ventricular dysfunction and to maintain cardiac output; and (5) postoperative management of pulmonary hypertension to ensure recovery from surgery. Last, this scientific statement highlights the paucity of evidence to support perioperative pulmonary hypertension management and identifies areas of uncertainty and opportunities for future investigation.

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Section: Perioperative Risk Of Ph In Noncardiac Surgerymentioning

confidence: 99%

Evaluation and Management of Pulmonary Hypertension in Noncardiac Surgery: A Scientific Statement From the American Heart Association

Rajagopal¹,

Ruetzler²,

Ghadimi³

et al. 2023

Circulation

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show abstract

“…Предлагаются некоторые общие рекомендации по предоперационному обследованию пациентов с ЛГ [6,298,302,303]:…”

Section: предоперационная подготовкаunclassified

“…Крайне важно поддерживать функцию ПЖ и избегать провоцирующих событий, которые могли бы вызвать легочную вазоконстрикцию (увеличение постнагрузки ПЖ) или системную гипотензию (снижение перфузии ПЖ) [303].…”

Section: послеоперационный периодunclassified

Assessment and modification of cardiovascular risk in non-cardiac surgery. Clinical guidelines 2023

Sumin,

Duplyakov,

Belyalov

et al. 2023

Russ J Cardiol

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Results of emergency colectomy in nonagenarians and octogenarians previously labeled as prohibitive surgical risk

Carr

NeCamp

2022

Eur J Trauma Emerg Surg

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Perioperative management of patients with severe pulmonary hypertension in major orthopedic surgery: experience-based recommendations

Cited by 8 publications

References 42 publications

Evaluation and Management of Pulmonary Hypertension in Noncardiac Surgery: A Scientific Statement From the American Heart Association

Evaluation and Management of Pulmonary Hypertension in Noncardiac Surgery: A Scientific Statement From the American Heart Association

Assessment and modification of cardiovascular risk in non-cardiac surgery. Clinical guidelines 2023

Results of emergency colectomy in nonagenarians and octogenarians previously labeled as prohibitive surgical risk

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