Intraoperative management of pulmonary arterial hypertension in infants and children

Purpose of review Pediatric pulmonary arterial hypertension (PAH) continues to be a considerable problem to the pediatric anesthesiologist, even if its management has seen remarkable advances in the recent year. It is important that anesthesiologists caring for children with PAH be aware of the increased risk, understand the pathophysiology of PAH, and form an appropriate anesthetic management plan. A review of some of the latest medical advances will provide the reader with a better understanding of the most current anesthetic management options. Recent findings The literature reviewed demonstrates sustained clinical and hemodynamic improvement in children with various types of PAH as well as increased survival in patients with idiopathic PAH using current treatment strategies. This article will provide an overview of how the current treatment and anesthetic strategies of idiopathic PAH in children have advanced over the last several years. Summary The first important aspect of anesthetic management is to provide adequate intraoperative anesthesia and analgesia while minimizing increases in pulmonary vascular resistance and myocardial function. Depending on the procedure, these goals can be met with the administration of either sedation/analgesia or general anesthesia together with new drugs for PAH treatment in association with a high potential for adverse events.