Anaesthetic management of a patient with idiopathic pulmonary arterial hypertension, suprasystemic pulmonary artery pressures and carcinoma of the ascending colon*

A 35-year-old woman with severe pulmonary arterial hypertension underwent open hemicolectomy with cholecystectomy under combined general and epidural anaesthesia. Intra-operative pulmonary artery pressure, as measured by Swan-Ganz catheter, was suprasystemic and managed with inodilators. She developed postoperative right ventricular dysfunction requiring inotropes, incremental pulmonary vasodilators and prolonged oxygen supplementation. One year after surgery, she is recurrence-free with oxygen saturations of 88–90% on air. This case highlights that with meticulous care and multidisciplinary team input, patients with severe pulmonary arterial hypertension can have favourable outcomes after major cancer surgery.