PULMONER HİPERTANSİYONLU OLGULARDA ANESTEZİK YAKLAŞIMLARIMIZIN RETROSPEKTİF İNCELENMESİ

An Erratum to this article was published on August 31, 2023. https://dergipark.org.tr/en/pub/kutfd/article/1348441

Abstract

Amaç: Pulmoner hipertansiyon (PH), pulmoner kan akımının azalmasıyla sonuçlanan pulmoner vasküler yataktaki bir bozukluktur. Çalışmamızda preoperatif PH’si bulunan olgularda anestezik yaklaşımlarımızı araştırmayı amaçladık. Gereç ve Yöntemler: Çalışmaya Kasım 2018-Mart 2021 tarihleri arasında anestezi altında operasyona alınan, preoperatif tetkiklerinde ekokardiyografide Pulmoner arter basıncı yüksekliği (PAB≥25mmHg) saptanan hastalar dahil edildi. Hastaların cinsiyetleri, yaşları, ek hastalıkları, transtorasik ekokardiyografileri bulguları, operasyon sırasında uygulanan anestezi tipleri, operasyon süreleri, postoperatif servis/yoğun bakım takip süreleri ve postoperatif ortaya çıkan komplikasyonlar ve mortalite incelendi. Bulgular: Çalışmaya alınan hastaların 46’sı kadın, 31’i erkekti. Yaş ortalamaları 68.71±15.03 idi. Hastaların %2.6’sında ek hastalık gözlenmezken, %97.4’ünde ek hastalık mevcuttu. Hastalara uygulanan anestezi tipine göre değerlendirdiğimizde; hastaların %89.6’sı genel anestezi altında opere olurken, %10.4’ü rejyonel anesteziyle opere olmuştur. Vaka sonrasında hastaların %51.9’u servise çıkarken, % 48.1’i yoğun bakıma çıkmıştır. 77 hastadan 9’unda ölüm gözlenirken, 68’i hastaneden taburcu olmuştur. Hastaların %76.6’sında komplikasyon gözlenmezken, en sık görülen komplikasyon % 9.1 oranında enfeksiyondur. Sonuç: Preoperatif pulmoner hipertansiyonu bulunan hastaları PH derecelerine göre sınıfladığımızda; uygulanan anestezi şekli, hastaların postoperatif servis, yoğun bakım takip süreleri, postoperatif taburculuk ve mortalite oranları arasında anlamlı bir farklılık olmadığı gözlenmiştir. PH’si bulunan hastaya anestezik yaklaşımla ilgili ulusal kılavuzlara, prospektif çalışmalara ihtiyaç olduğu kanaatindeyiz.

Keywords

• Pulmoner hipertansiyon
• anestezi
• mortalite

Retrospective Investigation of Our Anesthetic Approaches in Pulmonary Hypertension Patients

An Erratum to this article was published on August 31, 2023. https://dergipark.org.tr/en/pub/kutfd/article/1348441

Abstract

Objective: Pulmonary hypertension (PH) is a disorder of the pulmonary vascular bed that results in decreased pulmonary blood flow. In our study, we aimed to investigate our anesthetic approaches in patients with preoperative PH. Material and Methods: Patients who underwent surgery under anesthesia between November 2018 and March 2021 with elevated Pulmonary arterial pressure (PAP≥25mmHg) in echocardiography in their preoperative examinations were included in the study. The gender, age, comorbidities, transthoracic echocardiographies of the patients, types of anesthesia applied during the operation, operation times, postoperative service/intensive care unit follow-up periods, postoperative complications and mortality were examined. Results: Of the patients included in the study, 46 were female and 31 were male. The mean age was 68.71±15.03. While no additional disease was observed in 2.6% of the patients, an additional disease was present in 97.4% of them. When we evaluate according to the type of anesthesia applied to the patients; 89.6% of the patients were operated under general anesthesia, and 10.4% of them were operated under regional anesthesia. After the operation, 51.9% of the patients were admitted to the ward, and 48.1 % were admitted to the intensive care unit. While 9 of 77 patients died, 68 were discharged from the hospital. While complications were not observed in 76.6% of the patients, the most common complication was infection with a rate of 9.1%. Conclusion: When we classify patients with preoperative PH according to degrees; it was observed that there was no significant difference between the anesthesia method applied, the postoperative service, intensive care follow-up periods of the patients, postoperative discharge and mortality rates. We believe that there is a need for national guidelines and prospective studies about the anesthetic approach of patients with PH.

Keywords

• Pulmonary hypertension
• anesthesia
• mortality

References

1. Gropper MA (Edited by). Miller’s Anesthesia. İn: Wijeysundera DN, Finlayson E. Preop Evaluation. 9th Edition, Philadelphia: Elsevier, 2020:952-3.
2. Pritts CD, Pearl RG. Anesthesia for patients with pulmonary hypertension. Curr Opin Anaesthesiol 2010;23(3):411-6.
3. Fox C, Kalarickal PL, Yarborough MJ, Jin JY. Perioperative management including new pharmacological vistas for patients with pulmonary hypertension for noncardiac surgery. Curr Opin Anesthesiol. 2008;21(4):467–72.
4. Pilkington SA, Taboada D, Martinez G. Pulmonary hypertension and its management in patients undergoing non-cardiac surgery. Anaesthesia. 2015;70(1):56-70.
5. Carmosino MJ, Friesen RH, Doran A, Ivy DD. Perioperative complications in children with pulmonary hypertension undergoing noncardiac surgery or cardiac catheterization. Anesth Analg. 2007;104(3):521.
6. Caddigan S, Granlund B. Anesthesia For Patients With Pulmonary Hypertension Or Right Heart Failure. In: StatPearls [Internet]. 2022.
7. Hill NS, Roberts KR, Preston IR. Postoperative pulmonary hypertension: etiology and treatment of a dangerous complication. Respir Care 2009;54(7):958–68.
8. Rodriguez RM, Pearl RG. Pulmonary hypertension and major surgery. Anesth Analg. 1998;87(4):812-5.

9. Mekontso-Dessap A, De Prost N, Girou E, Braconnier F, Lemaire F, Brun- Buisson C, et al. B-type natriuretic peptide and weaning from mechanical ventilation. Intensive Care Med. 2006;32(10):1529-36.
10. Shah AC, Ma K, Faraoni D, Oh D, Rooke GA, Van Norman GA. Self-reported functional status predicts post-operative outcomes in non-cardiac surgery patients with pulmonary hypertension. PLoS One. 2018;13(8):e0201914.
11. Seyfarth HJ, Wirtz H, Gille J, Gerlach S, Grachtrup S, Winkler J, et al. Management and Outcome of Surgery in Patients with Severe Pulmonary Hypertension-A Single Center Experience. Pneumologie. 2016;70(2):117-22.
12. Kaw R, Pasupuleti V, Deshpande A, Hamieh T, Walker E, Minai OA. Pulmonary hypertension: an important predictor of outcomes in patients undergoing non-cardiac surgery. Respir Med. 2011;105(4):619-24.
13. Kruthiventi SC, Kane GC, Sprung J, Weingarten TN, Warner ME. Postoperative pulmonary complications in contemporary cohort of patients with pulmonary hypertension. Bosn J Basic Med Sci. 2019;19(4):392-99.
14. Meyer S, McLaughlin VV, Seyfarth HJ, Bull TM, Vizza CD, Gomberg-Maitland M, et al. Outcomes of noncardiac, nonobstetric surgery in patients with PAH: an international prospective survey. Eur Respir J. 2013;41(6):1302-7.
15. Gunt C, Çekmen N. Pulmoner Hipertansiyon ve Weaning. J Turkish Soc Intensive Care. 2016;14(3):68-79.