Anesthetic management of a patient with acute pulmonary hypertension for laparoscopic low anterior resection

Anesthetic management of patients with acute pulmonary hypertension (PH) for noncardiac surgery has received little attention in the literature. We present a case of acute PH due to pulmonary embolism for laparoscopic low anterior resection. A thorough preoperative assessment followed by invasive hemodynamic monitoring was done. Factors precipitating pulmonary vasoconstriction were avoided, and intravenous nitroglycerine infusion was used to control PH perioperatively. The problems encountered were increased airway pressure caused by pneumoperitoneum and Trendelenburg position.