Anesthesia Tutorial of the Week Quiz

1) Echocardiography remains the gold standard investigation for diagnosis of pulmonary hypertension

2) There are usually clear symptoms to aid diagnosis of pulmonary hypertension

3) The aetiology of pulmonary hypertension is similar throughout the world.

4) Right heart failure is a common presentation of severe pulmonary hypertension

5) A high PaCO2 (>6kpa) should be targeted throughout the perioperative period.

6) Beta-blockers should be the first choice agent for rate control in atrial fibrillation in patients with pulmonary hypertension

7) A reasonable intraoperative cardiac index goal should be ≥ 2.2 L/min/m2

8) Post-operative care for patients with more advanced pulmonary hypertension should take place in a high dependency environment

9) Pulmonary arterial vasodilators and vasopressor agents are commonly used in the peri-operative management of pulmonary hypertension patients.

10) All patients with pulmonary hypertension should be managed with sildenafil

11) Pre-capillary haemodynamic values for diagnosis of pulmonary hypertension include: mPAP > 20mmHg, PAWP, < 15mmHg and PVR > 3 WU

12) Pulmonary hypertensive crisis occurs when the right ventricle is unable to maintain cardiac output in the presence of acute elevations in pulmonary vascular resistance (PVR).

13) Regional techniques are particularly useful for managing postoperative pain in patients with pulmonary hypertension

14) Spinal anaesthesia should be the first line anaesthetic technique if it is not contraindicated in patients with pulmonary hypertension.

15) 15. Pulmonary function testing is important to help diagnosis of underlying lung disease.

16) Almost all patients should be managed with 100% oxygen if concerns are raised regarding a pulmonary hypertensive crisis episode.

17) Intubation and ventilation ensure a secure airway to allow efficient and controlled ventilation

18) Pre- and post-capillary disease is characterised by mPAP >20mmHg, PAWP >15mmHg and PVR >3WU following right heart catheterisation

19) The European Society of Cardiology / European Respiratory Society 2015 guidelines for the diagnosis and treatment of PH use CPET derived variables as perioperative prognostic factors.

20) Treatment for pulmonary hypertension is normally started when the mPAP >25mmHg.