Abstract
Recent studies have emphasized the complex regulation of the pulmonary circulation. This increased understanding should result in new therapeutic approaches in the treatment of hypoxia and pulmonary hypertension. This review will discuss some of the recent advances in our understanding of the pulmonary circulation. The effects of anesthetics on the pulmonary circulation are reviewed, emphasizing the multiple modulatory systems which are altered by specific anesthetic agents. The therapeutic role of inhaled nitric oxide, and the modulatory role of endogenous nitric oxide, on the pulmonary circulation are discussed. New insights into the mechanism of hypoxic pulmonary vasoconstriction (HPV) are presented. Clinical advances in the epidemiology of pulmonary hypertension, the use of vasodilators, the role of single lung transplantation, and the anesthetic management of pulmonary hypertension are discussed. Pulmonary capillary pressure (PCP) and its dependence on the longitudinal distribution of pulmonary vascular resistance are reviewed. Finally, the role of the pulmonary circulation in acute lung injury is emphasized.
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