sábado, 18 de abril de 2015

Hipertensión pulmonar y embarazo/Pregnancy in pulmonary hypertension

Hipertensión pulmonar en el embarazo: Manejo crítico
Pulmonary Hypertension in Pregnancy: Critical Care Management
Adel M. Bassily-Marcus, Carol Yuan, John Oropello, Anthony Manasia, Roopa Kohli-Seth, and Ernest Benjamin
Pulmonary Medicine
Volume 2012 (2012), Article ID 709407, 9 pages
Pulmonary hypertension is common in critical care settings and in presence of right ventricular failure is challenging to manage. Pulmonary hypertension in pregnant patients carries a high mortality rates between 30-56%. In the past decade, new treatments for pulmonary hypertension have emerged. Their application in pregnant women with pulmonary hypertension may hold promise in reducing morbidity and mortality. Signs and symptoms of pulmonary hypertension are nonspecific in pregnant women. Imaging workup may have undesirable radiation exposure. Pulmonary artery catheter remains the gold standard for diagnosing pulmonary hypertension, although its use in the intensive care unit for other conditions has slowly fallen out of favor. Goal-directed bedside echocardiogram and lung ultrasonography provide attractive alternatives. Basic principles of managing pulmonary hypertension with right ventricular failure are maintaining right ventricular function and reducing pulmonary vascular resistance. Fluid resuscitation and various vasopressors are used with caution. Pulmonary-hypertension-targeted therapies have been utilized in pregnant women with understanding of their safety profile. Mainstay therapy for pulmonary embolism is anticoagulation, and the treatment for amniotic fluid embolism remains supportive care. Multidisciplinary team approach is crucial to achieving successful outcomes in these difficult cases.

La embarazada con hipertensión pulmonar. Una revisión
The pregnant patient with pulmonary artery hypertension. A review.
Frost EA.
Middle East J Anaesthesiol. 2011 Jun;21(2):199-206.
Anestesia para cesárea en dos mujeres con hipertensión pulmonar severa secundaria a estenosis mitral
Anaesthetic management for caesarean section surgery in two pregnant women with severe pulmonary hypertension due to mitral valve stenosis.
Celik M, Dostbil A, Alici HA et al.
Balkan Med J. 2013 Dec;30(4):439-41. doi: 10.5152/balkanmedj.2013.8416. Epub 2013 Dec 1.
BACKGROUND: Mitral stenosis is the most important and common cardiac complication seen during pregnancy. Conception is discouraged in cases where pulmonary hypertension develops during the course of mitral stenosis. Successful general and regional anaesthetic interventions have been reported in some cases of severe pulmonary hypertension. CASE REPORTS: We present our experiences with anaesthetic management in two pregnant patients with pulmonary hypertension due to mitral valve stenosis. CONCLUSION: We preferred to continue spinal anaesthesia because gradually increasing the local anaesthetic dose during the procedure may minimise probable undesirable haemodynamic changes, such as hypotension and tachycardia.
KEYWORDS: Mitral Stenosis; caesarean section; pulmonary hypertension; regional anaesthesia
Helen Gharaee
Anestesia y Medicina del Dolor
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