Geriatric Anesthesia: A Practical Guide

Pulmonary Hypertension and Geriatric Patients

Author(s): Stuart Pasch and Irwin Gratz *

Pp: 137-154 (18)

DOI: 10.2174/9789815238877124010011

* (Excluding Mailing and Handling)


Pulmonary hypertension is a common and life-threatening condition, characterized by elevated blood pressure in the pulmonary artery, which supplies blood to the lungs. This condition is typically classified into five groups based on etiology. The etiology of pulmonary hypertension in the elderly is complex and multifactorial. Some of the common causes of pulmonary hypertension in this population include leftsided heart disease, chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), and pulmonary embolism. The initial evaluation determines the cause, which guides the appropriate treatment. The most common causes in the elderly arise from left heart disease and the sequela of COPD. Long-standing disease can result in pulmonary hypertension leading to right heart failure and potentially catastrophic consequences in a patient population with decreased physiologic reserve. Anesthesia and surgery in patients with pulmonary hypertension pose a significant risk of complications including death. Acute right ventricular decompensation can result from various physiological changes induced by anesthesia and sedation. Adequate risk assessment and individualized care are essential components of care. Efforts to avoid increases in pulmonary vascular resistance are keys to anesthetic management. However, despite the increase of pulmonary hypertension in the geriatric population, limited studies are dedicated to this group.

Keywords: Chronic obstructive pulmonary disease, Left heart failure, Pulmonary vascular physiology, Pulmonary hypertension, Pulmonary Hypoxic pulmonary vasoconstriction, Right heart failure.

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