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Perioperative management of Pulmonary Vascular Resistance (Intraop…
Perioperative management of Pulmonary Vascular Resistance
Preop - adequate analgesia to prevent excessive sympathetic activation
Intraop
Planning
Invasive monitoring (ART, CVC)
Senior anaesthetist (consider cardiac anaesthetist)
Inotrope prep
Anaesthetic
GA vs Spinal
General measures
Avoid hypoxia, hypercarbia, acidosis
Avoid shivering and hypothermia
Minimise SNS stimulation
Avoid N20 and Ketamine
Pulmonary artery manipulation specific
Consider Milrinone, NO, Iloprost
MR specific measures
Maintain volume
SVR: balance for coronary and myocardial perfusion vs minimizing MR
Maintain sinus rhythm with HR 80-100 to promote forward flow
Postop
HDU/ICU post op
Analgesia
Ongoing MDT input