Things to Avoid in Anesthesia for Pregnant with Pulmonary hypertension

Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status.

1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with
NYHA III ,IV.
Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO)
The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose)

2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis.
TEE is better cardiac monitor/Arteial line is mandatory.

3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR

4-If MV to be started, avoid High TV and PEEP

5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes decrease in SVR and increase the PVR. Also Both ergometrine and PG F2 alfa are contraindicated. PGE is safe.

6-Avoid hypercarbia, Acidosis, and light anesthesia

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