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Perioperative Management of Patients With Severe Pulmonary Hypertension in Major Orthopedic Surgery: Experience-Based Recommendations


Perioperative Management of Patients With Severe Pulmonary Hypertension in Major Orthopedic Surgery: Experience-Based Recommendations

Hans-Jürgen Seyfarth et al. GMS Interdiscip Plast Reconstr Surg DGPW.


Introduction: It is known that pulmonary hypertension is associated with worse outcome in both cardiac and non-cardiac surgery. The aims of our retrospective analysis were to evaluate the outcomes of our patients with pulmonary hypertension undergoing major orthopedic surgery and to give experience-based recommendations for the perioperative management.

Material and methods: From 92 patients with pulmonary hypertension undergoing different kinds of surgical procedures from 2011-2014 in a tertiary academic hospital we evaluated 16 patients with major orthopedic surgery for perioperative morbidity and mortality.

Results: Regarding the in-hospital morbidity and mortality, one patient died postoperatively due to pulmonary infection and right heart failure (6.25%) and 6 patients suffered significant postoperative complications (37.5%; bleeding = 1, infection = 1, wound healing deficits = 3; dysrhythmia = 1).

Conclusion: Our data show that major orthopedic surgery is feasible with satisfactory outcome even in cases of severe pulmonary hypertension by an individualized, disease-adapted interdisciplinary treatment concept.

Keywords: general anesthesia; intraoperative monitoring; local anesthesia; perioperative management; pulmonary hypertension.


Table 1
Table 1. Classification of pulmonary hypertension (Nice [8])
Table 2
Table 2. Hemodynamic characteristics in patients with pulmonary hypertension (mod. [9], [10])
Table 3
Table 3. Therapy of pulmonary hypertension: approved drugs (mod. [12], [13], [14])
Table 4
Table 4. Clinical findings in patients with pulmonary hypertension (mod. [17])
Table 5
Table 5. Functional classification of pulmonary hypertension (WHO 1998) [18]
Table 6
Table 6. Intraoperative monitoring: recommendation for patients with PH (mod. [22])
Table 7
Table 7. Authors recommendations: human, structural and technical requirements for the perioperative management of patients with severe pulmonary
Table 8
Table 8. Intraoperative “basic treatment” to avoid an increase of pulmonary arterial pressure (mod. [22], [24], [26])
Table 9
Table 9. Specific interventions for therapy of intra- and/or postoperative
increase of pulmonary arterial pressure (mod. [22], [24], [27])
Table 10
Table 10. Patients characteristics
Table 11
Table 11. Operation characteristics, complications and outcome
Figure 1
Figure 1. Clinical findings in a patient with chronic right heart insufficiency and severe pulmonary hypertension
Figure 2
Figure 2. Intraoperative selective pulmonary vasodilation with inhaled iloprost via ultrasonic nebulizer (m-neb®, nebutec Elsenfeld, Germany) in the ventilatory circuit
Figure 3
Figure 3. Mechanisms of acute right heart failure (adapted from [22])

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    1. Ramakrishna G, Sprung J, Ravi BS, Chandrasekaran K, McGoon MD. Impact of pulmonary hypertension on the outcomes of noncardiac surgery: predictors of perioperative morbidity and mortality. J Am Coll Cardiol. 2005 May;45(10):1691–1699. doi: 10.1016/j.jacc.2005.02.055. Available from: - DOI - DOI - PubMed
    1. Rodriguez RM, Pearl RG. Pulmonary hypertension and major surgery. Anesth Analg. 1998 Oct;87(4):812–815. - PubMed
    1. Roberts NV, Keast PJ. Pulmonary hypertension and pregnancy – a lethal combination. Anaesth Intensive Care. 1990 Aug;18(3):366–374. - PubMed
    1. Reich DL, Bodian CA, Krol M, Kuroda M, Osinski T, Thys DM. Intraoperative hemodynamic predictors of mortality, stroke, and myocardial infarction after coronary artery bypass surgery. Anesth Analg. 1999 Oct;89(4):814–822. - PubMed
    1. Shimizu T, Takahashi H, Matsumiya N, Miyabe M, Tanaka M. Unsuccessful anesthetic management for cesarean section in a patient with primary pulmonary hypertension. Masui. 2007 Aug;56(8):949–952. - PubMed