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Principles and Practice of Anesthesia for Thoracic Surgery pp 537–548Cite as

Anesthesia for Pulmonary Thromboendarterectomy

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Abstract

Chronic thromboembolic pulmonary hypertension results from repeated or unresolved emboli in the pulmonary circulation, and occurs in 3–4% of patients suffering acute pulmonary embolism. Pulmonary thromboendarterectomy is an endarterectomy of the entire pulmonary vascular tree, and is the preferred treatment for chronic thromboembolic pulmonary ­hypertension. The most common presenting symptom of chronic thromboembolic pulmonary hypertension is exertional dyspnea. The diagnosis is confirmed with echocardiography, right-sided cardiac catheterization, and pulmonary angiogram. Patients with chronic thromboembolic pulmonary hypertension, when left untreated, develop a small-vessel vasculopathy that mimics idiopathic pulmonary hypertension. Monitoring includes femoral and radial arterial ­pressures, processed EEG, pulmonary artery pressures, and transesophageal echocardiography. Anesthetic induction and maintenance are tailored to hemodynamic stability, right ventricular coronary perfusion pressure, and right ventricular support. Factors that lead to increased pulmonary vascular resistance, such as light anesthesia, acidosis, and hypoxemia, should be avoided. Pulmonary vasodilators such as nitric oxide and milrinone are generally ineffective in chronic thromboembolic pulmonary hypertension, but should be available for management of patients with small-vessel vasculopathy.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, University of California Medical Center, San Diego, CA, USA

    Gerard Manecke MD

  2. Department of Anesthesiology, University of California, San Diego, CA, USA

    Dalia Banks MD

  3. Department of Cardiothoracic Surgery, UCSD Medical Center, San Diego, CA, USA

    Michael Madani MD, FACS

  4. Department of Cardiothoracic Surgery, University of California, San Diego Medical Center, San Diego, CA, USA

    Stuart Jamieson MD, FRCS, FACS, FAACP, FACC

Authors
  1. Gerard Manecke MD
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  2. Dalia Banks MD
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  3. Michael Madani MD, FACS
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  4. Stuart Jamieson MD, FRCS, FACS, FAACP, FACC
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Editor information

Editors and Affiliations

  1. University of Toronto, Staff Anesthesiologist, Professor of Anesthesia, Toronto, M5G 2C4, Ontario, Canada

    Peter Slinger, MD, FRCPC

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Manecke, G., Banks, D., Madani, M., Jamieson, S. (2011). Anesthesia for Pulmonary Thromboendarterectomy. In: Slinger, MD, FRCPC, P. (eds) Principles and Practice of Anesthesia for Thoracic Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0184-2_38

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  • DOI: https://doi.org/10.1007/978-1-4419-0184-2_38

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