# Neuraxial anesthesia for patients with severe pulmonary arterial hypertension undergoing urgent open abdominal surgeries: two case reports

## TL;DR

This paper reports two cases where neuraxial anesthesia was safely used for abdominal surgeries in patients with severe pulmonary hypertension, avoiding general anesthesia.

## Contribution

Demonstrates the safe use of neuraxial anesthesia in patients with severe pulmonary hypertension during urgent abdominal surgeries.

## Key findings

- Neuraxial anesthesia was successfully used without circulatory collapse in two patients with severe PH.
- Vasoconstrictors were administered intraoperatively to maintain hemodynamic stability.
- The cases suggest neuraxial anesthesia may be a viable option for similar patients.

## Abstract

There is no consensus regarding the choice of anesthetic method for patients with pulmonary hypertension (PH). We report two cases in which neuraxial anesthesia was safely performed without general anesthesia during open abdominal surgery in patients with severe PH.

Case 1: A 59-year-old woman had an atrial septal defect and a huge abdominal tumor with a mean pulmonary arterial pressure (PAP) of 39 mmHg and pulmonary vascular resistance (PVR) of 3.5 Wood units. Case 2: A 23-year-old woman who had hereditary pulmonary artery hypertension (mean PAP, 65 mmHg; PVR, 16.45 Wood units). Both patients underwent open abdominal surgery under neuraxial anesthesia without circulatory collapse with intraoperative administration of vasoconstrictors.

Although anesthetic care must be personalized depending on the pathology and severity of PH, neuraxial anesthesia may be an option for patients with severe PH undergoing abdominal surgery.