Intraoperative management of pulmonary arterial hypertension in infants and children--corrected and republished article.

PURPOSE OF REVIEW: Pediatric pulmonary arterial hypertension (PAH) continues to be a considerable problem to the pediatric anesthesiologist even if its management has seen remarkable advances in recent years. It is important that anesthesiologists caring for children with PAH be aware of the increased risk, understand the pathophysiology of PAH, form an appropriate anesthetic management plan. A review of some of the latest medical advances will provide the reader with a better understanding of the most current anesthetic management options.

RECENT FINDINGS: The literature reviewed demonstrate sustained clinical and hemodynamic improvement in children with various types of PAH as well as increased survival in patients with idiopathic PAH using current treatment strategies. This article will provide an overview of the current treatment and anesthetic strategies about idiopathic PAH in children over the last years.

SUMMARY: The first important aspect of anesthetic management is to provide adequate intraoperative anesthesia and analgesia while minimizing increases in pulmonary vascular resistance and myocardial. Depending on the procedure, these goals can be met with the administration of either sedation/analgesia or general anesthesia together with new drugs for PAH treatment in association with a high potential for adverse events.