What is a clinical scenario for a female patient with pulmonary hypertension (PH) undergoing laparoscopic cholecystectomy?

Updated: Sep 11, 2019
  • Author: Swapnil Khoche, MBBS, DNB, FCARCSI; Chief Editor: Sheela Pai Cole, MD  more...
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Answer

Answer

A 54-year-old, 5'4" (163 cm), 70-kg female patient with a known history of severe PH presents for an elective laparoscopic cholecystectomy.  A right-heart catheterization report in her chart from 4 months previously documents elevated RAP (12 mm Hg), as well as elevated RV pressure (42/15 mm Hg). TTE shows a severely dilated RV and a moderately dilated RA. However, the patient is in no apparent distress, and there is no evidence of jugular venous distention, hepatomegaly, or anasarca.

Before induction an arterial line is placed, and baseline blood pressure is 126/72 mm Hg. The patient is preoxygenated and induced with fentanyl, lidocaine, propofol, and rocuronium. The airway is secured, and the surgical procedure starts with the establishment of pneumoperitoneum. Tachycardia (to 128 beats/min) is noted, and blood pressure decreases dramatically (to 78/32 mm Hg). The anesthesia provider asks for release of abdominal insufflation, then administers ephedrine and phenylephrine, with subsequent improvement in MAP.


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