A 38-year-old woman with idiopathic pulmonary arterial hypertension (mean PA pressure 52 mmHg, WHO functional class III) on bosentan and sildenil is posted for elective cholecystectomy. Which haemodynamic goal is MOST important to maintain?

• A Avoid hypoxia, hypercarbia, and acidosis ✓
• B Maintain systemic hypotension to reduce afterload
• C Aggressively preload with 2 litres of crystalloid
• D Maintain tachycardia to improve right ventricular output

Explanation

In pulmonary arterial hypoxia, hypercarbia, and acidosis all cause pulmonary vasoconstriction, which further elevates pulmonary artery pressure and can precipitate right ventricular failure. These triggers must be strictly avoided. Hypoxia and hypercarbia are far more dangerous than any single anaesthetic drug choice in this setting.

Reference: Miller's Anaesthesia, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.