Perioperative anesthesia management for pregnant patients with pulmonary arterial hypertension

To explore and summarize our experience of perioperative anesthesia management for pregnant patients with pulmonary arterial hypertension（PAH）undergoing cesarean section.

A retrospective case-control trial was performed on 45 pregnant patients with PAH who underwent cesarean section in our hospital from February 17, 2015 to May 19, 2022. The perioperative anesthesia management were analyzed and summarized.

These 45 PAH pregnant patients who underwent cesarean section completed all related examinations before operation, and the best time for delivery was determined through multidisciplinary collaborative diagnosis and treatment. Scientific anesthesia monitoring and management were carried out during the operation, and vasoactive drugs and blood volume supplementation were applied reasonably and effectively to maintain the stable vital signs during the operation. Only 1 case died of cardiac and respiratory failure due to pulmonary hypertension crisis intraoperatively, and the remaining 44 cases（97.8%）completed cesarean section safely. Among them, 33 cases（73.3%）returned to the obstetric ward, and the other 11（24.4%）were transferred to ICU for further treatment after operation. One of them with severe PAH died after being transferred to ICU due to cardiogenic shock. The higher risk grade of PAH, the incidence of adverse outcomes and adverse effects on the fetus were higher.

On the basis of multidisciplinary collaborative diagnosis and treatment and adequate preoperative assessment and preparation, combination of scientific and effective anesthesia management and especially, focusing on the puerpera with severe PAH is an important strategy for perioperative anesthesia management of pregnant PAH patients during cesarean section.