Kaw reported risk factors for postoperative complications for a patient with pulmonary hypertension. The author is from the Cleveland Clinic.

Patient selection: pulmonary hypertension


Types of surgery associated with postoperative complications include:

(1) heart and lung transplantation

(2) pneumonectomy

(3) liver transplantation


Preoperative findings associated with postoperative complications:

(1) significant right ventricle dysfunction

(2) severe hypoxemia


Perioperative factors associated with postoperative complications:

(1) fluid resuscitation with hypervolemia

(2) hypothermia

(3) hypoxia

(4) withdrawal of vasodilators

(5) general anesthesic agents and/or sedatives

(6) spinal anesthesia (rapid sympatholytic effect with fall in blood pressure and/or bradycardia)

(7) hypovolemia and/or significant blood loss

(8) hypercarbia and/or acidosis


Complications may include:

(1) worsening of pulmonary hypertension

(2) right ventricular failure

(3) right ventricular ischemia

(4) hypotension

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