{
  "abstract": "Pulmonary hypertension (PH) is a hemodynamic and pathophysiologic condition associated with increased perioperative morbidity and mortality, particularly in patients undergoing cardiac or high-risk non-cardiac surgery. Inhaled pulmonary vasodilators (iPVs) offer a targeted strategy to reduce pulmonary vascular resistance (PVR) and improve right ventricular (RV) function while minimizing systemic hypotension. Traditional vasodilators such as nitroglycerin and sodium nitroprusside lack pulmonary specificity and can exacerbate systemic hypotension. Inhaled agents including nitric oxide (NO), epoprostenol (iEPO), iloprost, milrinone (iMIL) and levosimendan provide selective pulmonary vasodilation with more favorable hemodynamic profiles. This narrative review summarizes current evidence and clinical considerations for the use of iPVs in the perioperative management of PH and discusses pharmacokinetics, delivery mechanisms, adverse effects, and logistical considerations for these agents. New emerging PH therapies are included based on early clinical trial data as they have the potential to impact perioperative care in the future. Overall, iPVs represent a valuable tool in the perioperative care of patients with PH. Continued research is needed to refine clinical protocols, evaluate emerging agents, and establish outcome-based evidence for their routine use.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL; Corresponding author: Rebecca Klingbeil, DNP, 4500 San Pablo Road, Jacksonville, FL 32246.",
    "Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden",
    "Division of Clinical Pharmacy, Advanced Heart Failure & Pulmonary Hypertension, J.W. Ruby Memorial Hospital, Morgantown, WV",
    "Department of Anesthesiology, University of Wisconsin, Madison, WI",
    "Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Rebecca Klingbeil, DNP"
    },
    {
      "affs": [
        1
      ],
      "name": "Clara Hjalmarsson, MD, PhD"
    },
    {
      "affs": [
        2
      ],
      "name": "Bailey Colvin, PharmD"
    },
    {
      "affs": [
        3
      ],
      "name": "Katherine Kozarek, MD"
    },
    {
      "affs": [
        4
      ],
      "name": "Anna Bovill Shapiro, MD"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fqhehjs3znhy1.bib",
  "cited_by": 0,
  "doi": "10.1016/j.jhlto.2026.100627",
  "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S2950133426001485",
  "id": "fqhehjs3znhy1",
  "issns": [
    "2950-1334"
  ],
  "landing_url": "https://doi.org/10.1016/j.jhlto.2026.100627",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RC581-951"
    ],
    [
      "lcc",
      "RD1-811"
    ],
    [
      "openalex",
      "2740|Pulmonary Hypertension Research and Treatments"
    ]
  ],
  "openalex": "W7167893411",
  "pdf_url": "https://www.jhltopen.org/article/S2950-1334(26)00148-5/pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-05",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/fqhehjs3znhy1.ris",
  "sources": [
    {
      "first_seen": "2026-11-05T14:21:20Z",
      "native_id": "0a055fe6e12544bfba09abe6e6df3fd9",
      "source": "doaj",
      "url": "https://doi.org/10.1016/j.jhlto.2026.100627"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "lcc:RD1-811",
      "subfield": "surgery"
    }
  ],
  "title": "Inhaled pulmonary vasodilators in pulmonary hypertension: Perioperative use and clinical considerations",
  "title_text": "Inhaled pulmonary vasodilators in pulmonary hypertension: Perioperative use and clinical considerations",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T14:20:33Z",
  "url": "https://research.draconitic.com/paper/fqhehjs3znhy1",
  "venue": "JHLT Open",
  "versions": []
}