Treatment of pulmonary hypertension during surgery with nitric oxide and vasodilators

Abstract

552CAN J ANESTH 2000 / 47: 6 / pp [552][553][554][555] Purpose: To describe the effects of the combination of several therapies on the pulmonary circulation and cardiac function in a patient with severe pulmonary hypertension. Clinical features:We report the case of a female patient with chronic secondary pulmonary hypertension and cardiac failure who underwent right hemicolectomy under general anesthesia. Insertion of a pulmonary artery catheter before the operation revealed pulmonary artery pressure (PAP) of 55/24 mmHg which was lowered moderately by 40 parts per million (ppm) inhNO. During surgery, the patient presented an episode of atrial fibrillation with a slow, irregular heart rate of 45-50 min -1 and variable systemic pressure. A dipyridamole DPD (0.2 mg·kg -1 ) bolus stabilized systemic pressure and increased heart rate and cardiac output. However, PAP did not change. Nitroglycerine infusion was started at 10 mg·hr -1 shortly after the initiation of DPD. The patient responded favourably to combined inhNO, intravenous DPD and NTG therapy with a marked and sustained reduction of PAP and a systemic hemodynamic stability. Conclusion:We conclude that: 1) in combination with inhNO, DPD does not augment the inhNO-induced decrease in PAP; 2) DPD improves the hemodynamic profile and elevates cardiac output; 3) therapeutic combination (inhaled NO, NTG, DPD) has a potent effect on pulmonary pressure in cardiac failure patients.Objectif : Décrire les effets d'une combinaison de thérapies sur la circulation pulmonaire et la fonction cardiaque chez une patiente qui présente une sévère hypertension pulmonaire. ) a permis de stabiliser la pression générale et d'augmenter la fréquence et le débit cardiaques. La PAP n'a toutefois pas changé. Une perfusion de nitroglycérine a été amorcée avec 10 mg·h -1 peu après le début du DPD. La patiente a bien réagi à la thérapie combinée de NOinh, de DPD intraveineux et de NTG, ce qui a entraîné une réduction marquée et soutenue de la PAP et une stabilité hémodynamique générale. Conclusion :Nous en concluons que : 1) en combinaison avec le NOinh, le DPD n'accentue pas la baisse de PAP induite par le NOinh 2) le DPD améliore les caractéristiques hémodynamiques et augmente le débit cardiaque 3) la NTG stimule la vasodilatation pulmonaire induite par le NOinh chez les patients atteints d'insuffisance cardiaque.

Effects of cAMP modulators on long-chain fatty-acid uptake and utilization by electrically stimulated rat cardiac myocytes

“…Although many PDE inhibitors are currently being used as cardiotonic agents for heart-failure patients [35][36][37][38][39], negative side effects have been documented, and their long-term use could eventually lead to increased mortality [40,41]. The ability of IBMX, milrinone and dipyridamole to increase FAT\CD36mediated FA uptake, as observed in the present study, may suggest that prolonged use of these agents induces a chronic shift from glucose to FA utilization.…”

Peri‐operative trans‐oesophageal echocardiography and nitric oxide during general anaesthesia in a patient with Eisenmenger's syndrome

“…Nitric oxide is a potent pulmonary artery vasodilator, and is commonly used in the assessment of reversibility of pulmonary hypertension [3], as well as during cardiac surgery and for long-term therapy [8]. It has been used to lower pulmonary artery pressures in patients with Eisenmenger's syndrome undergoing major non-cardiac surgery [9,10]. We started at 5 ppm and increased to 15 ppm as TOE showed evidence of worsening of the shunt.…”

Reversible Catastrophic Fat Embolism: A Case Report

“…Second, nitroglycerine was given in an attempt to relieve the acute pulmonary hypertension. Its use has been advocated for the relief of pulmonary hypertension [12]. Nitroglycerin is known to convert to nitric oxide (NO), leading to vasodilatation [13].…”