Perioperative Management of Patients With Pulmonary Hypertension

In 1973, when the World Health Organization organized the first international conference on pulmonary hypertension (PH), there were no effective therapies and median survival for patients with primary PH (now termed idiopathic pulmonary arterial hypertension) was under three years. Today, there are multiple therapies and survival has more than doubled. As a result, more patients with PH undergo anesthesia and surgery. Successful perioperative management of a patient with PH requires multiple steps (Table 1): recognizing the disorder, diagnosing the etiology, assessing the severity of the disease, assessing the risks and benefits of anesthesia and surgery, developing an anesthetic plan, and managing systemic hypotension and right heart failure.