Abstract The perioperative management of pulmonary hypertension in a patient with Eisenmenger syndrome, the most advanced form of associated pulmonary artery hypertension (PAH), who required a ...sigmoidectomy is presented. The treatment for pulmonary hypertension was switched from oral sildenafil to intravenous epoprostenol to avoid the unexpected discontinuation of vasodilation during the perioperative period. The scheduled perioperative conversion should be considered for patients with severe PAH undergoing major abdominal surgery to ensure the stabilization of pulmonary and systemic hemodynamics.
A 69-year-old man with chronic thromboembolic pulmonary hypertension (CTEPH) was on amblatory oxygen inhalation therapy (3 L/min) and scheduled for percutaneous transluminal pulmonary angioplasty ...(PTPA). The patient's New York Heart Association functional status was class III with recent worsening of dyspnea and apparent leg edema. Transthoracic echocardiography revealed right ventricular enlargement with mean pulmonary artery pressure of 42 mmHg. After PTPA, he was complicated with postoperative reperfusion pulmonary edema, and noninvasive positive pressure ventilation (NPPV) was applied immediately. Hypoxemia was successfully treated with 15 days of NPPV. Although mean pulmonary artery pressure was unchanged, his brain natriuretic peptide level decreased from preoperative 390.3 to postoperative 44.3 pg/dL. In addition, total pulmonary resistance decreased from preoperative 18 to postoperative 9.6 wood unit·m2. The patient was discharged on day 25 with SpO2 of 95% on 5 L/min of oxygen inhalation. Because pulmonary edema is a postsurgical life-threatening complication following PTPA, application of NPPV should be considered.
A 75-year-old woman with primary pulmonary hypertension was on medical therapy and ambulatory oxygen inhalation therapy for 7 years. The patient had right femoral fracture and was admitted to our ...hospital. She had also suffered from asthma for 2 years, and her vital capacity was 1.35 l with forced expiratory volume in 1 second 0.79 l, and with her mean pulmonary artery pressure 60 mmHg. Open reduction and internal fixation were performed under spinal anesthesia using isobaric bupivacaine 6 mg with fentanyl 10 microg, and the patient was discharged on postoperative 31 day with no major complications. One year after the surgery, she had left femoral fracture, and surgery was performed under spinal anesthesia using isobaric bupivacaine 6 mg with fentanyl 10 microg. With its minimal effects on hemodynamics, we speculate that spinal anesthesia using a low dose of isobaric bupivacaine can be a choice for patients with pulmonary hypertension.
Hypoxemia and oxygen saturation by pulse oximeter Kanai, Riichiro; Uzawa, Koji; Moriyama, Kiyoshi ...
Journal of the Japanese Society of Intensive Care Medicine,
2014/03/01, Letnik:
21, Številka:
2
Journal Article
Although rib involvement may occur in patients with multiple myeloma, the development of pathological flail chest is rare. We experienced a patient with multiple myeloma who presented with flail ...chest and respiratory failure. A 63-year-old man with multiple myeloma experienced multiple rib fractures and complained of chest pain and dyspnea. The patient underwent chemotherapy, but treatment was discontinued because he developed drug-induced hypersensitivity syndrome. His dyspnea and chest pain progressed, and he was admitted to the ICU. Even after endotracheal intubation, flail chest of the lower thoracic segments were evident bilaterally on inspiration. A PEEP was applied and increased up to 15 cmH2O to stabilize his flail chest. The patient underwent a tracheostomy, as the duration of ventilatory support was expected to be lengthy. The PEEP was gradually decreased to 6 cmH2O on day 27 after endotracheal intubation, while avoiding the occurrence of flail chest. After treatment with a high dose of dexamethasone starting on day 73, his chest pain was gradually alleviated, and his flail chest disappeared, as evidenced by a CT scan. The patient was weaned from long-term ventilatory support on day 131.
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