Pharmacology of the Pulmonary Circulation

The pulmonary vasculature is a complex system and studies of the effects of anesthetic drugs on this system are often contradictory. A balanced anesthetic technique with adherence to the hemodynamic goals of maintenance of right ventricular preload and right coronary perfusion is the safest choice for patients with PHTN. There are no absolute contraindications to most anesthetic drugs in patients with pulmonary hypertension. Inhaled pulmonary vasodilators can be used to optimize hemodynamic variables perioperatively, although effects on gas exchange are variable.