243. Pulmonary Hypertension

Question 1

What is pulmonary hypertension (PH) in children associated with?

Answer 1

Significant morbidity and mortality

In the perioperative setting, children diagnosed with PH are at a 20-fold higher risk for cardiac arrest and death.

Question 2

What are the two main classification schemes for pediatric PH?

Answer 2

1. WHO Nice classification
2. Panama classification system

The WHO classification divides pediatric PH into 5 groups, while the Panama classification distinguishes between 10 categories.

Question 3

Define pulmonary hypertension.

Answer 3

Resting mean pulmonary artery pressure equal to or greater than 25 mm Hg diagnosed by right heart catheterization.

Question 4

What is pulmonary arterial hypertension (PAH)?

Answer 4

Increased mPAP and PVR with PAWP equal to or less than 15 mm Hg.

Question 5

What is the normal range for mean pulmonary artery pressure (mPAP)?

Answer 5

14 ± 3.3 mm Hg.

Question 6

What factors increase pulmonary vascular resistance (PVR)?

Answer 6

Hypoxemia, hypercapnia, acidemia, pain

These factors can lead to increased PVR, which is crucial in managing PH.

Question 7

What are the categories of the WHO classification for PAH?

Answer 7

1. Idiopathic PAH
2. Heritable PAH
3. PAH associated with congenital heart disease.

Question 8

What is the key distinction in pulmonary hypertension between precapillary and postcapillary PH?

Answer 8

Precapillary PH has restriction in the pulmonary precapillary bed, while postcapillary PH is due to left heart disease.

Question 9

What should be evaluated preoperatively in children with PH?

Answer 9

Airway and cardiopulmonary system status, recent cardiac studies, functional status.

Question 10

What is the recommended method for intravenous induction in children with PH?

Answer 10

Intravenous induction is safer due to immediate management of complications.

Question 11

What monitoring is essential during anesthesia for patients with PH?

Answer 11

Five-lead electrocardiogram and availability of resuscitation equipment.

Question 12

What are the components of postoperative care for patients with PH?

Answer 12

Breathing management, analgesia, body temperature control.

Question 13

True or False: A pulmonary hypertensive crisis is limited to the intraoperative period.

Answer 13

False.

Question 14

What can trigger a pulmonary hypertensive crisis?

Answer 14

Hypoxia, hypercapnia, acidemia, noxious stimuli, hypothermia, vagal stimuli.

Question 15

List some treatment options for a pulmonary hypertensive crisis.

Answer 15

1. 100% FiO2
2. Hyperventilation
3. Inhaled nitric oxide
4. Sodium bicarbonate
5. Inotropes and vasopressors.

Question 16

Fill in the blank: The normal value for pulmonary vascular resistance (PVR) is _______.

Answer 16

20–130 dynes/s/cm5.

Question 17

What complications are patients with PH at higher risk for in the postoperative period?

Answer 17

Respiratory events leading to cardiac arrest.

Question 18

What is the role of vasopressin in anesthesia for PH patients?

Answer 18

It does not cause pulmonary vasoconstriction.

Question 19

What factors can decrease pulmonary vascular resistance (PVR)?

Answer 19

Supplemental oxygen, inhaled nitric oxide, prostacyclin analogues.