Effect of sildenafil in the management of preoperative pulmonary hypertension

Pulmonary arterial hypertension (PAH) is a disabling chronic disorder of the pulmonary vasculature, which is characterized by increased pulmonary artery pressure (PAP) as a result of increased pulmonary vascular resistance (PVR). The most accepted hemodynamic definition of PH is a mean PAP >25mmHg. It is accidentally discovered preoperatively through performing an echocardiogram in patients suspected of having PH, as these patients suffer from dyspnea which is the most frequently presenting symptom. Additional symptoms include fatigue, weakness, angina, syncope, and lower limb edema. The aim of the study was to evaluate the efficacy and safety of preoperative oral sildenafil administration in the management of pulmonary hypertensive patients scheduled for non-cardiac surgery. 30 Patients, (ASA II–III), suffering from pulmonary hypertension and scheduled for non-cardiac surgery were randomly assigned to one of two groups. Group I received 25mg sildenafil twice daily for one week before surgery. Group II received placebo in the same way. PAP, LVEF and RVEF (through echocardiogram), heart rate, mean arterial blood pressure, SpO2 (oxygen saturation), functional class and 6-min walk distance were measured and recorded at baseline and one week after treatment in both groups. Sildenafil significantly reduced PAP and improved exercise tolerance, functional class, 6-min walk distance and SpO2 without significant alteration of heart rate and mean arterial blood pressure. The study showed effective and safe administration of preoperative oral sildenafil in the management of pulmonary hypertensive patients scheduled for non-cardiac surgery.