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Pulmonary hypertensive crisis — FRCA Final MCQ

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HardCardiothoracic and Vascular AnaesthesiaPulmonary hypertensive crisisFRCA Final

A 70-year-old man with severe pulmonary hypertension is anaesthetised for abdominal surgery. During emergence he becomes hypoxic and hypotensive; echocardiography shows a dilated right ventricle with poor contraction. End-tidal CO2 has fallen and there is no major bleeding. What is the most appropriate anaesthetic technique?

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Correct answer: D — Improve oxygenation, reduce pulmonary vascular resistance and support RV perfusion

Pulmonary hypertensive crisis with RV failure is treated by correcting hypoxia, acidosis and hypercapnia, reducing pulmonary vascular resistance and maintaining systemic pressure for RV coronary perfusion. Large indiscriminate fluid boluses may worsen RV dilation and septal shift. Beta-blockade can impair compensatory contractility. Pulmonary vasodilators and inotropes may be needed with expert help.

Reference: Association of Anaesthetists pulmonary hypertension peri-operative guidance; RCoA Final FRCA Syllabus 2026