Special anaesthesia: pulmonary hypertension: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Special anaesthesia: pulmonary hypertension

Sample item

Which perioperative factor increases pulmonary vascular resistance and should be avoided in a patient with pulmonary hypertension?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Hypoxia, hypercarbia and acidosis

Hypoxia, hypercarbia, acidosis, hypothermia, pain and sympathetic stimulation all raise pulmonary vascular resistance and can precipitate acute right heart failure. Management aims to keep oxygenation and mild hypocapnia and to avoid nitrous oxide. Inhaled nitric oxide or prostacyclin may be used to lower resistance.

Option by option

  • A. Inhaled nitric oxide

    Inhaled nitric oxide is a pulmonary vasodilator and is used to treat the problem.

  • B. Alkalosis

    Alkalosis dilates the pulmonary circulation.

  • C. Hypocapnia

    Hypocapnia and alkalosis lower pulmonary vascular resistance.

  • D. Hypoxia, hypercarbia and acidosis (correct)

    Correct. These factors constrict the pulmonary vasculature and strain the right ventricle.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is D, Hypoxia, hypercarbia and acidosis. Hypoxia, hypercarbia, acidosis, hypothermia, pain and sympathetic stimulation all raise pulmonary vascular resistance and can precipitate acute right heart failure.

Why is "Inhaled nitric oxide" not the answer?

Inhaled nitric oxide is a pulmonary vasodilator and is used to treat the problem.

Why is "Alkalosis" not the answer?

Alkalosis dilates the pulmonary circulation.

Why is "Hypocapnia" not the answer?

Hypocapnia and alkalosis lower pulmonary vascular resistance.

What concept does this question test?

It tests Special anaesthesia: pulmonary hypertension in Anaesthesia. Management aims to keep oxygenation and mild hypocapnia and to avoid nitrous oxide. Inhaled nitric oxide or prostacyclin may be used to lower resistance.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Special anaesthesia: pulmonary hypertension?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.