Management of Severe Scoliosis with Pulmonary Arterial Hypertension: A Single-Center Retrospective Case Series Study

作者：Qiang Li, Fei Zeng, Tao Chen, Mengqiu Liang, Xue Lei, Yijian Liang, Chuandong Zheng, He Huang · 发表于：Geriatric Orthopaedic Surgery & Rehabilitation · 年份：2022 · DOI：10.1177/21514593221080279 · 被引用次数：12 · 研究领域：Pulmonary Hypertension Research and Treatments、Cardiac, Anesthesia and Surgical Outcomes、Scoliosis diagnosis and treatment

Aims: To determine the impact of anesthesia encountered and to optimize the treatment of perioperative pulmonary arterial hypertension (PAH) in an effort to improve perioperative management and reduce complications. Methods: We conducted a retrospective analysis of scoliosis patients with PAH who underwent scoliosis surgery. Results: During this period, we identified a total of 22 patients. Their mean age was 22.18 ± 2.11 years. 16 PAH patients (72.72%) received PAH-specific treatment. Only Propofol-based TIVA was used intraoperatively. During the procedure, pulmonary artery catheters and PICCO catheters were placed in all patients to monitor intraoperative and postoperative mPAP, MAP, PRVI and SRVI. During tracheal intubation and intraoperative awake testing, mPAP generally tended to increase in all patients. 6 patients (27.27%) received intraoperative PAH-Specific therapy. All patients received oral sildenafil (75-100 mg/d orally), and 9 patients received postoperative oral sildenafil combined with nebulized iloprost (20 μg/d); intravenous treprostinil (2 ng/kg/min started and titrated to 10-17.5 ng/kg/min); or bosentan (250 mg/d) postoperatively. 7 patients (31.82%) reported postoperative complications, including 2 cases of respiratory failure requiring reintubation, 1 case of right heart failure, 2 cases of superficial surgical site infection, 1 case of fluid and electrolyte and acid-base imbalances, 2 cases of pneumonia and 1 case of pulmonary oedema with fluid overload....