[Anesthetic management of patients with pulmonary arterial hypertension (PAH)].

BACKGROUND

Pulmonary arterial hypertension (PAH) is associated with significant perioperative risk due to the severity of cardiac dysfunction related to the RV Tei index greater than 0.83. We evaluated the car- diovascular function during anesthesia to elucidate the characteristics of severity of PAH.

METHODS

Nine patients undergoing central venous catheterization under general anesthesia (seven patients) and local anesthesia with sedation (two patients) were studied. RV Tei index of five patients were greater than 0.83 (severe) and in four patients RV Tei index was below 0.83 (moderate). Bioimpedance method was used to determine stroke volume (SV) and cardiac output (CO) non-invasively throughout anesthesia. The correlation between the changes in SV and CO was evaluated by using least squares method.

RESULTS

Demographic data showed mean age of 16.6 years, height of 146.9 cm and weight of 39.7 kg. Correlation coefficient of SV and CO in the patients with severe cardiac dysfunction was 0.0-0.21, while in those with moderate cardiac dysfunction it was 0.49-0.93.

CONCLUSIONS

In patients with severe PAH, it was demonstrated that CO is maintained by the change in heart rate (HR) but not by SV It is suggested that the control of HR in patients with PAH is of clinical importance in order to maintain CO, if RV index is greater than 0.83.