Update on Perioperative Pediatric Pulmonary Hypertension Management.
This is a comprehensive review of paediatric pulmonary hypertension from the John Hopkins University School of Medicine, Baltimore, USA. The article is split into two sections; the first summarises definitions, diagnosis, investigation and treatment of the disease, and the second highlights anaesthetic considerations preoperative, intraoperative and postoperative and the management of pulmonary hypertensive crisis.
The new areas to highlight are the modified definition of pulmonary hypertension to a mean pulmonary arterial pressure >20mmHg (based on the adult definition) but that it must be in a child over three months of age in contrast to the previous definition of mean pulmonary arterial pressure > 25mmHg. It is implied the change has come about because the new definition is more statistically relevant. A very detailed summary of preferred echocardiography investigations and mathematical calculations of pulmonary arterial pressure follows whilst other investigations have limited applicability in paediatrics.
Anaesthetic management is essentially unchanged from what has been described previously, but there is a new suggestion of a pre-surgical risk assessment model and multidisciplinary collaboration which may be useful in planning non-cardiac surgery, including involvement of surgeons, cardiac anaesthetist, intensive care, theatre schedulers and ECMO teams. There is also a useful table that displays the impact of anaesthetic agents, vasopressors and inotropes on systemic vascular resistance, pulmonary vascular resistance and contractility.
The benefits of the paper are the introduction of the new definition of pulmonary arterial hypertension and pre-surgical risk assessment model in paediatrics, however most of the rest of the content has already been described in the literature.
Reviewed by Dr Patrick Rubie