TY - JOUR T1 - Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension JF - European Respiratory Journal JO - Eur Respir J SP - 1294 LP - 1302 DO - 10.1183/09031936.00113009 VL - 35 IS - 6 AU - L. C. Price AU - D. Montani AU - X. Jaïs AU - J. R. Dick AU - G. Simonneau AU - O. Sitbon AU - F. J. Mercier AU - M. Humbert Y1 - 2010/06/01 UR - http://erj.ersjournals.com/content/35/6/1294.abstract N2 - The anaesthetic management and follow-up of well-characterised patients with pulmonary arterial hypertension presenting for noncardiothoracic nonobstetric surgery has rarely been described. The details of consecutive patients and perioperative complications during the period January 2000 to December 2007 were reviewed. Repeat procedures in duplicate patients were excluded. Longer term outcomes included New York Heart Association (NYHA) functional class, 6-min walking distance and invasive haemodynamics. A total of 28 patients were identified as having undergone major (57%) or minor surgery under general (50%) and regional anaesthesia. At the time of surgery, 75% of patients were in NYHA functional class I–II. Perioperative deaths occurred in 7%. Perioperative complications, all related to pulmonary hypertension, occurred in 29% of all patients and in 17% of those with no deaths during scheduled procedures. Most (n = 11, 92%) of the complications occurred in the first 48 h following surgery. In emergencies (n = 4), perioperative complication and death rates were higher (100 and 50%, respectively; p<0.005). Risk factors for complications were greater for emergency surgery (p<0.001), major surgery (p = 0.008) and a long operative time (193 versus 112 min; p = 0.003). No significant clinical or haemodynamic deterioration was seen in survivors at 3–6 or 12 months of post-operative follow-up. Despite optimal management in this mostly nonsevere pulmonary hypertension population, perioperative complications were common, although survivors remained stable. Emergency procedures, major surgery and long operations were associated with increased risk. ER -