Con: General Anesthesia Is Not Superior to Regional Anesthesia for Patients With Pulmonary Hypertension Undergoing Noncardiac Surgery

Abstract

PATIENTS with significant pulmonary hypertension (PH) are known high-risk surgical candidates because of an increased incidence of adverse cardiopulmonary outcomes. 1 Smilowitz NR Armanious A Bangalore S et al. Cardiovascular outcomes of patients with pulmonary hypertension undergoing noncardiac surgery. Am J Cardiol. 2019; 123: 1532-1537 Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar , 2 Lai H-C Lai H-C Wang K-Y et al. Severe pulmonary hypertension complicates postoperative outcome of non-cardiac surgery. Br J Anaesth. 2007; 99: 184-190 Abstract Full Text Full Text PDF PubMed Scopus (137) Google Scholar , 3 Fox C Kalarickal PL Yarborough MJ et al. Perioperative management including new pharmacological vistas for patients with pulmonary hypertension for noncardiac surgery. Curr Opin Anaesth. 2008; 21: 467-472 Crossref PubMed Scopus (26) Google Scholar , 4 Gille J Seyfarth H-J Gerlach S et al. Perioperative anesthesiological management of patients with pulmonary hypertension. Anesth Res Pract. 2012; 2012: 1-16 Crossref Scopus (42) Google Scholar Despite the significant morbidity and mortality risk and increasing frequency of PH among surgical candidates, 5 Sarkar MS Desai PM. Pulmonary hypertension and cardiac anesthesia: Anesthesiologist's perspective. Ann Card Anaesth. 2018; 21: 116-122 PubMed Google Scholar ,6 Pritts CD Pearl RG. Anesthesia for patients with pulmonary hypertension. Curr Opin Anaesth. 2010; 23: 411-416 Crossref PubMed Scopus (66) Google Scholar the optimal anesthetic approach to significant PH remains controversial. Caring for such patients requires continuous evaluation of the delicate balance between maximizing cardiopulmonary blood flow and minimizing factors known to worsen this condition. The authors of the present report believe that regional anesthesia (RA) affords a number of advantages over general anesthesia (GA) in providing safe, optimal, perioperative management of patients with PH undergoing noncardiac surgery.