Pharmacologic Treatment of the Adult Respiratory Distress Syndrome

[Anaesthesia and right ventricular failure]

OBJECTIVE

The purpose of this review was to present an update of the anaesthesic management in patients with right ventricular failure (RVF).

DATA SOURCES

All references obtained from the medical database Medline related to the area and more specifically during the last five years were reviewed.

DATA SYNTHESIS

The preanaesthesic visit leads to identify the etiology of RVF, to evaluate the functional reserve of the patient, to plan complementary exams and to inform the patients about the risks associated with the perioperative period. During the peroperative period, the monitoring depends of the severity of the illness; however the invasive monitoring of the systemic blood pressure seems always necessary. Any hemodynamic instability should be avoided during the peri-operative period. Since the risk of death is maximal in the first days after the anaesthesia, the patient is ideally managed in intensive care during this period.

CONCLUSION

Right ventricular failure is often mis-estimated. However, the perioperative morbidity and mortality of patients with RVF are important. In the perioperative period, the anaesthesiologist should identify patients at risk of right ventricular failure in order to adapt their management.

Effects of pentoxifylline on hemodynamics, gas exchange and multiple organ platelet sequestration in experimental endotoxic shock

In an intensive care setting we studied the effects of pentoxifylline on hemodynamics, gas-exchange and platelet sequestration in multiple organs in three groups of sheep exposed to endotoxin shock (n = 7 in each). Group P-E was given pentoxifylline before and group E-P after E. coli endotoxin infusion, while group E received normal saline (controls). The endotoxin infusion caused a three-fold increase in pulmonary artery pressure (PAP) and a significant decrease in mean arterial pressure (25-30%; MAP), respiratory compliance (CT; 60%) and arterial oxygen tension (65-70%; Pao2) in all groups after 30 min. After 4 h MAP had improved significantly in the pretreated animals (group P-E) and arterial pH, Pao2 and CT improved in both pentoxifylline-treated groups compared with the controls. On the other hand, the effects of endotoxin on PAP and cardiac index were not significantly influenced by pentoxifylline treatment. In addition, there was a pronounced platelet sequestration in the lungs and in the liver in groups E and E-P during the 4 h study, but in the pretreated group (group P-E) the changes were significantly less marked (P < 0.01). The wet-to-dry weight ratios of the lungs were significantly lower in both pentoxifylline-treated groups compared with the controls (P < 0.01). It was concluded that pentoxifylline modified the effects of endotoxin on hemodynamics, gas exchange and platelet sequestration in the lungs and liver in sheep when it was given prior to endotoxin. However, when it was given after hemodynamic and respiratory signs of shock had appeared, the effects were more moderate.