Skip to main content
Log in

Monitored anesthesia care with dexmedetomidine of a patient with severe pulmonary arterial hypertension for inguinal hernioplasty

  • Clinical Report
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

The presence of severe pulmonary arterial hypertension (PAH) is a significant risk factor of major perioperative cardiovascular complications in patients undergoing even non-cardiac surgery under anesthetic management. The most important aspect of perioperative care of PAH patients is to avoid pulmonary hypertensive crisis, which can be induced by alveolar hypoxia, hypoxemia, hypercarbia, metabolic acidosis, airway manipulations, and activation of the sympathetic nervous system by noxious stimuli. We report a case of successful monitored anesthesia care supplemented by dexmedetomidine for inguinal hernioplasty of a patient with severe PAH secondary to congenital heart disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Fischer LG, Van Aken H, Burkle H. Management of pulmonary hypertension: physiological and pharmacological considerations for anesthesiologists. Anesth Analg. 2003;96:1603–16.

    Article  PubMed  Google Scholar 

  2. Friesen RH, Williams GD. Anesthetic management of children with pulmonary arterial hypertension. Paediatr Anaesth. 2008;18:208–16.

    Article  PubMed  Google Scholar 

  3. Cannesson M, Earing MG, Collange V, Kersten JR. Anesthesia for noncardiac surgery in adults with congenital heart disease. Anesthesiology. 2009;111:432–40.

    Article  PubMed  Google Scholar 

  4. Sahebjami H, Sathianpitayakul E. Influence of body weight on the severity of dyspnea in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000;161:886–90.

    CAS  PubMed  Google Scholar 

  5. Badesch DB, Abman SH, Ahearn GS, Barst RJ, McCrory DC, Simonneau G, McLaughlin VV. Medical therapy for pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest. 2004;126:35S–62S.

    Article  PubMed  Google Scholar 

  6. Badesch DB, Abman SH, Simonneau G, Rubin LJ, McLaughlin VV. Medical therapy for pulmonary arterial hypertension: updated ACCP evidence-based clinical practice guidelines. Chest. 2007;131:1917–28.

    Article  PubMed  Google Scholar 

  7. Khairy P, Landzberg MJ. Adult congenital heart disease: toward prospective risk assessment of a multisystemic condition. Circulation. 2008;117:2311–2.

    Article  PubMed  Google Scholar 

  8. Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone–alphadolone. Br Med J. 1974;2:656–9.

    Article  CAS  PubMed  Google Scholar 

  9. Andropoulos DB, Stayer SA, Skjonsby BS, East DL, McKenzie ED, Fraser CD. Anesthetic and perioperative outcome of teenagers and adults with congenital heart disease. J Cardiothorac Vasc Anesth. 2002;16:731–6.

    Article  CAS  PubMed  Google Scholar 

  10. Honigmann P, Fischer H, Kurmann A, Audigé L, Schüpfer G, Metzger J. Investigating the effect of intra-operative infiltration with local anaesthesia on the development of chronic postoperative pain after inguinal hernia repair. A randomized placebo controlled triple blinded and group sequential study design [NCT00484731]. BMC Surg. 2007;7:22.

    Article  PubMed  Google Scholar 

  11. Bloor BC, Ward DS, Belleville JP, Maze M. Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. Anesthesiology. 1992;77:1134–42.

    Article  CAS  PubMed  Google Scholar 

  12. Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiology. 1992;77:1125–33.

    Article  CAS  PubMed  Google Scholar 

  13. Nathan AT, Marino BS, Hanna B, Nicolson SC. Novel use of dexmedetomidine in a patient with pulmonary hypertension. Paediatr Anaesth. 2008;18:782–4.

    Article  PubMed  Google Scholar 

  14. Toyama H, Wagatsuma T, Ejima Y, Matsubara M, Kurosawa S. Cesarean section and primary pulmonary hypertension: the role of intravenous dexmedetomidine. Int J Obstet Anesth. 2009;18:262–7.

    Article  CAS  PubMed  Google Scholar 

  15. Renes J, Glass PS, Lubarsky D, McEnvoy M, Martinez-Ruiz R. Intravenous anesthetics. In: Miller R, editor. Anesthesia. 7th ed. New York: Churchill Livingstone; 2009. p. 719–64.

    Google Scholar 

  16. Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg. 2000;90:699–705.

    Article  CAS  PubMed  Google Scholar 

  17. Apan A, Doganci N, Ergan A, Buyukkocak U. Bispectral index-guided intraoperative sedation with dexmedetomidine and midazolam infusion in outpatient cataract surgery. Minerva Anesthesiol. 2009;75:239–44.

    CAS  Google Scholar 

  18. Absalom AR, Menon DK. BIS and spectral entropy monitoring during sedation with midazolam/remifentanil and dexmedetomidine/remifentanil. Crit Care. 2009;13:137.

    Article  PubMed  Google Scholar 

  19. Kasuya Y, Govinda R, Rauch S, Mascha EJ, Sessler DI, Turan A. The correlation between bispectral index and observational sedation scale in volunteers sedated with dexmedetomidine and propofol. Anesth Analg. 2009;109:1811–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kiichi Hirota.

About this article

Cite this article

Shinohara, H., Hirota, K., Sato, M. et al. Monitored anesthesia care with dexmedetomidine of a patient with severe pulmonary arterial hypertension for inguinal hernioplasty. J Anesth 24, 611–613 (2010). https://doi.org/10.1007/s00540-010-0959-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-010-0959-5

Keywords

Navigation