Alia Dabbous, Sanaa Itani, Patricia Nehme

American University of Beirut, Department of Anesthesiology and Pain Medicine, Beirut, Lebanon

Corresponding author: Patricia Nehme, American University of Beirut, Department of Anesthesiology and Pain Medicine, Beirut, Lebanon.

Citation: Alia Dabbous, Sanaa Itani, Patricia Nehme (2025). Challenges in the Anesthetic Management of Patients with Severe Pulmonary Hypertension Undergoing Gastrointestinal Endoscopic Procedures Under Sedation. American J Case Rep Clin Imag. 2025; May 2(1).1-2.

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Abstract:

Introduction: Gastrointestinal (GI) endoscopic procedures nowadays are commonly performed requiring deep sedation. Sedation is associated with a risk of cardiopulmonary events, the leading cause of morbidity and mortality with GI endoscopies. Patients with pulmonary hypertension (PH) may be at a higher risk for perioperative complications. There is little evidence supporting any specific pre-procedure testing or anesthetic technique during the procedure. A multidisciplinary team approach can be implemented peri-operatively to guide preoperative assessment, intra-operative management, and post-operative care, and the procedure location could be moved to the operating rooms (ORs), or to the cardiac ORs if specialized equipment is needed. Our aim is to evaluate the safety of providing sedation for patients with pulmonary hypertension in the GI endoscopy unit when there is little time for adequate preoperative optimization and when cardiac ORs and special equipment are not readily available.

Methods: This is a case-series study describing the hemodynamic changes observed in 3 patients with pulmonary hypertension who presented to the GI endoscopy unit. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) software.

Results: Our study included 3 patients who underwent urgent gastroscopy and colonoscopy endoscopies for workup of anaemia. The average procedure time was 46 minutes. Sedation was delivered through Fentanyl 50 mcg boluses titrated to a maximal dose of 100 mcg, and a Propofol infusion at the rate of 25-30 mcg/kg/min for the 3 patients. Table 1 shows the various patient demographics, and indicates that there was no statistically significant change in the perioperative vital signs measured for every patient, including the heart rate (p=0.621), the systolic blood pressure (p=0.895), the diastolic blood pressure (p=0.849) and mean arterial pressure (p=0.856). Furthermore, mean satisfaction scores on a 10 point-scale were high in the 3 patients (9.3), the providing Anesthesiologists (9.6) and the gastroenterologists performing the procedure (9).

Conclusion: The perioperative management of patients with PH is complex, and to this day, evidence-based guidelines are not available. The main goal is to provide good patient comfort during the procedure while maintaining adequate hemodynamic. Our report suggests that sedation could be delivered safely for patients with pulmonary hypertension undergoing urgent GI endoscopy, especially in a resource limited setting, and sets the groundwork for future research investigating the disparity in outcomes, morbidity and mortality between procedures performed in the regular endoscopy unit and those performed in a more advanced theatre such as the cardiac units.

Keywords: sedation, pulmonary hypertension, gastroscopy, colonoscopy