Retrospective investigation of our anesthetic approaches in pulmonary hypertension patients

Objektive: Pulmonary hypertension (PH) is a disorder of the pulmonary vascular bed that results in decreased pulmonary blood flow. In terms of clinical anesthesia, the perioperative management of patients with PH varies depending on the pathological features present, functional clinical classification, hemodynamic status, and the success of current medical therapy. In our study, we aimed to investigate our anesthetic approaches in patients with preoperative PH. Materials and Methods: After the ethics committee approval, 77 patients with elevated PAP (PAP≥25 mmHg) on echocardiography between November 2018 and March 2021 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, additional disease was present in 97.4 % of them. The majör additional problem of patients was cardiac disease (61%), wheras the least problem was lung disease (15.6%). According to the echocardiography results, the patients' Ejection Fractions % (EF) (median (min-max)) were 60 (25-71), the median Pulmonary Arterial Pressures (PAP) were 40.04, the lowest was 25, and the highest was 100 mmHg. When we evaluate according to the type of anesthesia applied to the patients; 89.6% of the patients were operated under general anesthesia, 10.4% of them were operated under regional anesthesia. After the case, 51.9% of the patients were admitted to the ward, 48.1% were admitted to the intensive care unit. The operation and hospitalization times of the patients were 2.4 (1-6.9) and 6 (1-110) days, respectively. The mean duration of intensive care stay was 2.77±10.53 (min;0 max;90) days. 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 PH grades; 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. in patients with preoperative PH. We believe that there is a need for national guidelines and prospective studies on the anesthetic approach of patients with PH.