Pulmonary hypertension (PH) in children is a distinct entity related to lung growth and development. Significant advances in PH-targeted therapy have resulted in improved outcomes (contemporary 5-year survival 60–81% compared to 35% prior to advancements in treatment options); nevertheless, children with PH who present for procedures requiring sedation or general anesthesia present a challenge to the pediatric anesthesiologist. This chapter will discuss the perioperative care of the pediatric patient with PH. Table 48.1 summarizes essential elements of providing care in newborns, children and adolescents with pulmonary hypertension.
KeywordsPulmonary hypertension Pulmonary vascular hypertensive disease Pulmonary hypertensive crisis Pulmonary vascular resistance Right ventricular failure Pulmonary artery pressure
- 5.Cerro MJ, Abman S, Diaz G, Freudenthal AH, Freudenthal F, Harikrishnan S, et al. A consensus approach to the classification of pediatric pulmonary hypertensive vascular disease: report from the PVRI pediatric taskforce, Panama 2011. Pulm Circ. 2011;1(2):286–98.CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Hansmann G, Apitz C. Treatment of children with pulmonary hypertension. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK. Heart. 2016;102(Suppl 2):ii67–85.CrossRefPubMedGoogle Scholar
- 13.Williams GD, Philip BM, Chu LF, Boltz MG, Kamra K, Terwey H, et al. Ketamine does not increase pulmonary vascular resistance in children with pulmonary hypertension undergoing sevoflurane anesthesia and spontaneous ventilation. Anesth Analg. 2007;105(6):1578–84, table of contents.CrossRefGoogle Scholar
- 16.Laird TH, Stayer SA, Rivenes SM, Lewin MB, McKenzie ED, Fraser CD, et al. Pulmonary-to-systemic blood flow ratio effects of sevoflurane, isoflurane, halothane, and fentanyl/midazolam with 100% oxygen in children with congenital heart disease. Anesth Analg. 2002;95(5):1200–6, table of contents.CrossRefGoogle Scholar
- 20.Kaestner M, Schranz D, Warnecke G, Apitz C, Hansmann G, Miera O. Pulmonary hypertension in the intensive care unit. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric pulmonary vascular disease network, endorsed by ISHLT and DGPK. Heart. 2016;102(Suppl 2):ii57–66.CrossRefPubMedGoogle Scholar