Patient with pulmonary HTN on sildenafil

[YGK]

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Do you stop Viagra before elective surgery if patients on it for pulmonary HTN?

 

[chocomorsel]

I guess I have never encountered that, but I would say nope. You can plan and treat the hypotension.

 

[abolt18]

Do you stop Viagra before elective surgery if patients on it for pulmonary HTN?

Have always continued it, and even given the scheduled dose in the OR, per tube. I think it really depends on how bad they need it. How's the RV with and without it? How are the PA pressures with and without it in the past?

Ultimately I would err on the side of caution and keep it going and even give it in the OR if they're anesthetized during a scheduled dose.

 

[dhb]

Do you stop Viagra before elective surgery if patients on it for pulmonary HTN?

Only for urology cases.

Seriously i don't recall having that come up often but i would not discontinue.

 

[26B]

Effect of oral sildenafil citrate on intraoperative hemodynamics in patients with pulmonary hypertension undergoing valvular heart surgery

Pulmonary hypertension remains a major problem during the perioperative period for surgical correction of long-standing valvular heart disease. Silden…

www.sciencedirect.com

"Patient characteristics and baseline hemodynamics were similar between groups. Systolic and mean pulmonary arterial pressures and pulmonary vascular resistance were significantly lower in the sildenafil group at 30 minutes after medication, without any changes in mean systemic arterial pressure and systemic vascular resistance."

 

[dchz]

Effect of oral sildenafil citrate on intraoperative hemodynamics in patients with pulmonary hypertension undergoing valvular heart surgery

Pulmonary hypertension remains a major problem during the perioperative period for surgical correction of long-standing valvular heart disease. Silden…

www.sciencedirect.com

"Patient characteristics and baseline hemodynamics were similar between groups. Systolic and mean pulmonary arterial pressures and pulmonary vascular resistance were significantly lower in the sildenafil group at 30 minutes after medication, without any changes in mean systemic arterial pressure and systemic vascular resistance."

Mad props for you for coming up with the study.

However, it's worth pointing out the N is very small. Most people that undergo valvular surgery overwhelmingly classifies into group 2 PHTN (2/2 L heart disease). But most people that are on sildinafil are much more distributed towards the group 1 (Pulm Artery HTN), group 3 (intrinsic lung disease), and group 5 (mixed or unknown etiology). Therefore, your study quoted are not studying the same patient population as the ones presented in OP's question. I bet if they did the same study with group 1 patients, the results will be very different.


Regarding OP, the overwhelming amount of time, I would say no, do not stop the oral PDE 5 inhibitor. The downside of oral PDE 5 is mostly hypotension 2/2 preload, which can be easily treated. The downside of stopping PDE 5 inhibitor, although very rare, is RV failure, which can be hard to treat for most anesthesiologists. But it is worth pointing out that the type of PHTN matters in answering the question.

 

[Southpaw]

Do you stop Viagra before elective surgery if patients on it for pulmonary HTN?

If on it for pulm HTN, no I would not.

 

[GassYous]

As long as you avoid alpha 1 blockers and nitrates it's not an issue.

 

[vector2]

What @dchz said. Give it.

Also, you're probably not going to get immediate rebound pHTN from one day of sildenafil discontinuation but rebound does occur if it's d/c'ed for a few days-couple weeks. If the patient stops it for a few days because they thought they weren't supposed to take it before surgery, it could be bad news bears. People have gone to the hospital for RV failure after such abrupt discontinuations.

 

[coffeebythelake]

Do you stop Viagra before elective surgery if patients on it for pulmonary HTN?

NOPE
just avoid giving patient nitroglycerin or SNP