Pulmonary Vascular Responses to Nitrous Oxide in Patients with Normal and High Pulmonary Vascular Resistance

Schulte-Sasse, U.; Heß, W. R.; Tarnow, J.

doi:10.1097/00000542-198207000-00003

Cited by 160 publications

(42 citation statements)

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“…Their baseline characteristics, together with maternal and neonatal outcomes, are recorded in Table 1. Their mean age at the initial clinic visit was 27 years (median 25 years, range [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. There were seven primigravidas.…”

Section: Resultsmentioning

confidence: 99%

“…33 Vecuronium and atracurium have been used for muscle relaxation, the former being more cardiostable and the latter being better metabolised by the pregnant woman. Nitrous oxide was used in the first case (its suitability has been recommended by others 30,31 ), but as it has since been shown to be cardiodepressant as well as potentially increasing pulmonary vascular resistance in women with PH, 34 we have subsequently avoided its use.…”

Section: Anaesthetic Considerationsmentioning

confidence: 99%

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Pulmonary hypertension and pregnancy—a review of 12 pregnancies in nine women

Curry

Fletcher

Gelson

et al. 2012

BJOG

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Objective To report outcomes in a recent series of pregnancies in women with pulmonary hypertension (PH).Design Retrospective case note review. Setting Tertiary referral unit (Chelsea and Westminster and Royal Brompton Hospitals).Sample Twelve pregnancies in nine women with PH between 1995 and 2010.Methods Multidisciplinary review of case records.Main outcome measures Maternal and neonatal mortality and morbidity.Results There were two maternal deaths (1995 and 1998), one related to pre-eclampsia and one to arrhythmia. Maternal morbidity included postpartum haemorrhage (five cases), and one post-caesarean evacuation of a wound haematoma. There were no perinatal deaths, nine live births and three first-trimester miscarriages. Mean birthweight was 2197 g, mean gestational age was 34 weeks (range 26-39), and mean birthweight centile was 36 (range 5-60). Five babies required admission to the neonatal intensive care unit, but were all eventually discharged home. All women were delivered by caesarean section (seven elective and two emergency deliveries), under general anaesthetic except for one emergency and one elective caesarean performed under regional block.Conclusions Maternal and fetal outcomes for women with PH may be improving. However, the risk of maternal mortality remains significant, so that early and effective counselling about contraceptive options and pregnancy risks should continue to play a major role in the management of such women when they reach reproductive maturity.

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Section: Resultsmentioning

confidence: 99%

Section: Anaesthetic Considerationsmentioning

confidence: 99%

Pulmonary hypertension and pregnancy—a review of 12 pregnancies in nine women

Curry

Fletcher

Gelson

et al. 2012

BJOG

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“…Desflurane appears to exert worse pulmonary vascular effects than isoflurane, probably through sympathetic activation [42,43]. Some studies suggest that nitrous oxide as a supplemental anaesthetic agent may increase PVR, especially in those with pre-existing elevated PVR [44], and it may also adversely influence endothelial function [45]. An increase in adverse cardiovascular events following its use in major surgery has been observed [46], possibly also through adverse pulmonary vascular effects of increased sympathomimetic stimulation [47,48] or hypoxia [49], and a study addressing these questions is ongoing [50].…”

Section: Discussionmentioning

confidence: 99%

Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension

Price¹,

Montani²,

Jaïs³

et al. 2009

European Respiratory Journal

118

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The anaesthetic management and follow-up of well-characterised patients with pulmonary arterial hypertension presenting for noncardiothoracic nonobstetric surgery has rarely been described.The details of consecutive patients and perioperative complications during the period January 2000 to December 2007 were reviewed. Repeat procedures in duplicate patients were excluded. Longer term outcomes included New York Heart Association (NYHA) functional class, 6-min walking distance and invasive haemodynamics.A total of 28 patients were identified as having undergone major (57%) or minor surgery under general (50%) and regional anaesthesia. At the time of surgery, 75% of patients were in NYHA functional class I-II. Perioperative deaths occurred in 7%. Perioperative complications, all related to pulmonary hypertension, occurred in 29% of all patients and in 17% of those with no deaths during scheduled procedures. Most (n511, 92%) of the complications occurred in the first 48 h following surgery. In emergencies (n54), perioperative complication and death rates were higher (100 and 50%, respectively; p,0.005). Risk factors for complications were greater for emergency surgery (p,0.001), major surgery (p50.008) and a long operative time (193 versus 112 min; p50.003). No significant clinical or haemodynamic deterioration was seen in survivors at 3-6 or 12 months of post-operative follow-up.Despite optimal management in this mostly nonsevere pulmonary hypertension population, perioperative complications were common, although survivors remained stable. Emergency procedures, major surgery and long operations were associated with increased risk.

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“…Though N 2 O have the potential to increase PVR this effect is not significant. 9 Low volume ventilation and prevention of hypoxia also contributed to maintenance of PVR.…”

Section: Journal Of Society Of Anesthesiologists Of Nepalmentioning

confidence: 99%

A case of uncorrected tetralogy of Fallot with preeclampsia: an anesthetic challenge for cesarean section

Bhar

Maji

Das

et al. 2016

J. Soc. Anesth. Nep.

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Women with cardiovascular diseases may present for cesarean delivery. We present a case of anesthetic management for cesarean section in a patient with uncorrected tetralogy of Fallot complicated with preeclampsia. No definite guideline or information is available in the textbook or literature about the management of such a case. A 21 year primigravida was admitted in our institute with breathlessness on normal day to day life activity. Her blood pressure was 160/100 mmHg, oxygen saturation 85-86% in room air and she had ejection systolic murmur of grade three intensity along the left sternal border. Her echocardiography which was done in the first trimester revealed tetralogy of Fallot with moderate to severe right ventricular outlet obstruction with hypoplastic pulmonary artery and pulmonary valve. Proteinurea was detected on bedside urine examination. The patient was posted for emergency cesarean section due to non-reassuring fetal heart rate associated with preeclamsia. Magnesium sulfate 10 gm intramuscularly was given for seizure prophylaxis and general anesthesia was administered using etomidate as induction agent. The objective of anesthetic management mainly depends on maintaining of systemic vascular resistance and decreasing pulmonary vascular resistance. In preeclampsia systemic vascular resistance is already elevated. Thus treatment of preeclampsia may worsen cyanosis, so we avoided labetalol to reduce blood pressure. Intra-operative and post-operative periods were uneventful and baby had good apgar scores. So we can conclude that cesarean section in patient with both tetralogy of Fallot and preeclampsia can be managed successfully with general anesthesia using techniques which maintain systemic vascular resistance.

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Pulmonary Vascular Responses to Nitrous Oxide in Patients with Normal and High Pulmonary Vascular Resistance

Cited by 160 publications

References 0 publications

Pulmonary hypertension and pregnancy—a review of 12 pregnancies in nine women

Pulmonary hypertension and pregnancy—a review of 12 pregnancies in nine women

Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension

A case of uncorrected tetralogy of Fallot with preeclampsia: an anesthetic challenge for cesarean section

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