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Jaiswal SK, Memon SS, Lila A, Sarathi V, Goroshi M, Garg R, Barnabas R, Hemantkumar I, Patel RD, Oak S, Dalvi A, Garale M, Patil V, Shah NS, Bandgar T. Preoperative Amlodipine Is Efficacious in Preventing Intraoperative HDI in Pheochromocytoma: Pilot RCT. J Clin Endocrinol Metab 2021; 106:e2907-e2918. [PMID: 33839787 DOI: 10.1210/clinem/dgab231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Preoperative blockade with α-blockers is recommended in patients with pheochromocytoma/paraganglioma (PPGL). The data on calcium channel blockade (CCB) in PPGL are scarce. OBJECTIVE We aimed to compare the efficacy of CCB and α-blockers on intraoperative hemodynamic instability (HDI) in PPGL. METHODS In the interim analysis of this monocentric, pilot, open-label, randomized controlled trial, patients with solitary, secretory, and nonmetastatic PPGL were randomized to oral prazosin gastrointestinal therapeutic system (GITS) (maximum 30 mg, n = 9) or amlodipine (maximum 20 mg, n = 11). The primary outcomes were the episodes and duration of hypertension (systolic blood pressure ≥ 160 mmHg) and hypotension (mean arterial pressure < 60 mmHg) and duration of HDI (hypertension and/or hypotension) as a percentage of total surgical time (from induction of anesthesia to skin closure). RESULTS The median (IQR) episodes (2 [1-3] vs 0 [0-1]; P = 0.002) and duration of hypertension (19 [14-42] vs 0 [0-3] minutes; P = 0.001) and intraoperative HDI duration (22.85 ± 18.4% vs 2.44 ± 2.4%; CI, 8.68-32.14%; P 0.002) were significantly higher in the prazosin GITS arm than the amlodipine arm, whereas episodes and duration of hypotension did not differ between the 2 groups. There was no perioperative mortality. One patient had intraoperative ST depression on the electrocardiogram. The drug-related adverse effects were pedal edema (1 in amlodipine), dizziness (1 in prazosin GITS), and tachycardia (6 in prazosin GITS and 3 in amlodipine). CONCLUSION Preoperative blockade with amlodipine is an efficacious alternative to prazosin GITS in preventing intraoperative HDI in PPGL. Larger studies that compare preoperative blockade by amlodipine with other α-blockers like phenoxybenzamine and/or doxazosin in PPGL patients are warranted.
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Affiliation(s)
- Sanjeet Kumar Jaiswal
- Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra 400012,India
| | - Saba Samad Memon
- Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra 400012,India
| | - Anurag Lila
- Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra 400012,India
| | - Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka 560066, India
| | - Manjunath Goroshi
- Department of Endocrinology, Jawaharlal Nehru Medical College, Belagavi, Karnataka 590010, India
| | - Robin Garg
- Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra 400012,India
| | - Rohit Barnabas
- Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra 400012,India
| | - Indrani Hemantkumar
- Department of Anaesthesia, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra 400012, India
| | - Rajendra D Patel
- Department of Anaesthesia, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra 400012, India
| | - Shrikanta Oak
- Department of Anaesthesia, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra 400012, India
| | - Abhay Dalvi
- Department of Surgery, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra 400012, India
| | - Mahadeo Garale
- Department of Surgery, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra 400012, India
| | - Virendra Patil
- Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra 400012,India
| | - Nalini S Shah
- Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra 400012,India
| | - Tushar Bandgar
- Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra 400012,India
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The determination of real fluid requirements in laparoscopic resection of pheochromocytoma using minimally invasive hemodynamic monitoring: a prospectively designed trial. Surg Endosc 2019; 34:368-376. [PMID: 30976898 PMCID: PMC6946750 DOI: 10.1007/s00464-019-06777-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/02/2019] [Indexed: 02/07/2023]
Abstract
Background Hemodynamic instability is frequently observed during adrenalectomy for pheochromocytoma (PCC). Guidelines recommend liberal preoperative volume administration. However, it is unclear whether fluid deficiency or vasoplegia causes shifting hemodynamics and whether minimally invasive hemodynamic monitoring with esophageal Doppler (EDM) can help visualize intraoperative changes avoiding volume overload and complications. Methods Ten patients with biochemically verified PCC and five patients with hormonally inactive adrenal tumors (HIAT; control group) were treated following a strict protocol. During laparoscopic adrenalectomy, goal-directed fluid therapy was performed using EDM. Hemodynamic and biochemical data were documented. The primary outcome variables were fluid requirement and hemodynamic parameters. Results Applying EDM, total intraoperative fluid administration was slightly higher in PCC patients than in patients with HIAT (2100 ± 516 vs. 1550 ± 622 ml, p = 0.097; 12.9 ± 4.8 vs. 8.3 ± 0.7 ml kg−1 h−1, p = 0.014). Hemodynamics varied considerably within the PCC group and was associated with type and level of secreted catecholamines. Arterial blood pressure and systemic vascular resistance index reached their minimum in the 10-min period after resection of PCC. Without liberal fluid administration, an increase in cardiac index was observed in both groups comparing baseline measurements to end of surgery. This increase was statistically significant only in PCC patients (PCC: 2.31 vs. 3.15 l min−1 m−2, p = 0.005; HIAT: 2.08 vs. 2.56 l min−1 m−2, p = 0.225). Conclusions As vasoplegia, but not hypovolemia, was documented after tumor resection, there is no evidence that PCC patients profit from liberal fluid administration during laparoscopic adrenalectomy. To avoid volume overload, noninvasive techniques such as EDM should be routinely used to visualize the variable intraoperative course. Trial registration: ClinicalTrials.gov, Identifier: NCT01425710.
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Pio L, Avanzini S, Mattioli G, Martucciello G, Sementa AR, Conte M, Gigliotti A, Granata C, Leva E, Fagnani AM, Caccioppoli U, Tedesco N, Schleef J, Tirtei E, Siracusa F, D'Angelo P, Lelli Chiesa P, Miglionico L, Noccioli B, Severi E, Carlini C, Vaccarella F, Camoglio F, Cesaro S, Narciso A, Riccipetitoni G, Cecchetto G, Inserra A. Perioperative management of hypertensive neuroblastoma: A study from the Italian Group of Pediatric Surgical Oncologists (GICOP). J Pediatr Surg 2017; 52:1633-1636. [PMID: 28711167 DOI: 10.1016/j.jpedsurg.2017.06.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 06/13/2017] [Accepted: 06/29/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Hypertension (HT) is rarely reported in patients affected by Neuroblastoma (NB), and management guidelines are lacking. Clinical features and perioperative medical treatment in such patients were reviewed to 1) ascertain whether a shared treatment strategy exists among centers and 2) if possible, propose some recommendations for the perioperative management of HT in NB patients. METHODS A retrospective multicenter survey was conducted on patients affected by NB who presented HT symptoms. RESULTS From 2006 to 2014, 1126 children were registered in the Italian Registry of Neuroblastoma (RINB). Of these, 21 with HT (1.8%) were included in our analysis. Pre- and intraoperative HT management was somewhat dissimilar among the participating centers, apart from a certain consistency in the intraoperative use of the alpha-1 blocker urapidil. Six of the 21 patients (28%) needed persistent antihypertensive treatment at a median follow-up of 36months (range 4-96months) despite tumor removal. Involvement of the renal pedicle was the only risk factor constantly associated to HT persistency following surgery. A correlation between the presence of HT and the secretion of specific catecholamines and/or compression of the renal vascular pedicle could not be demonstrated. CONCLUSION Based on this retrospective review of NB patients with HT, no definite therapeutic protocol can be recommended owing to heterogeneity of adopted treatments in different centers. A proposal of perioperative HT management in NB patients is however presented. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Luca Pio
- Pediatric Surgery Unit, Istituto Giannina Gaslini, Genova; DINOGMI, Università Degli Studi di Genova.
| | | | - Girolamo Mattioli
- Pediatric Surgery Unit, Istituto Giannina Gaslini, Genova; DINOGMI, Università Degli Studi di Genova
| | - Giuseppe Martucciello
- Pediatric Surgery Unit, Istituto Giannina Gaslini, Genova; DINOGMI, Università Degli Studi di Genova
| | | | | | - Annarita Gigliotti
- Epidemiology Biostatistics and Committees Unit, Istituto Giannina Gaslini, Genova
| | | | - Ernesto Leva
- Pediatric Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano
| | - Anna Maria Fagnani
- Pediatric Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano
| | | | - Nino Tedesco
- Surgical Oncology Unit, A.O.R.N. Santobono Pausilipon, Napoli
| | - Jurgen Schleef
- Pediatric Surgery Unit, Ospedale Infantile Regina Margherita, Torino
| | - Elisa Tirtei
- Oncology Unit, Ospedale Infantile Regina Margherita, Torino
| | | | - Paolo D'Angelo
- Oncology Unit, A.R.N.A.S. Civico, Di Cristina and Benfratelli Hospital, Palermo
| | | | - Lucia Miglionico
- Oncology Unit, Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - Bruno Noccioli
- Pediatric Surgery Unit, Ospedale Pediatrico Meyer, Firenze
| | - Elisa Severi
- Pediatric Surgery Unit, Ospedale Pediatrico Meyer, Firenze
| | - Claudio Carlini
- Pediatric Surgery Unit, ASN SS: Antonio e Biagio e Cesare Arrigo, Alessandria
| | | | - Francesco Camoglio
- Pediatric Surgery Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona
| | - Simone Cesaro
- Oncology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona
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Rousson D, Rimmelé T, Ber CE, Allaouchiche B, Bouvet L. [Incidental finding of phaeochromocytoma during surgery: the anaesthesiologist's nightmare]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2012; 31:172-5. [PMID: 22285940 DOI: 10.1016/j.annfar.2011.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 10/26/2011] [Indexed: 10/14/2022]
Abstract
We report the case of a patient who presented hypertension paroxysmal with acute pulmonary oedema followed by cardiocirculatory arrest during gynaecological surgery for resection of latero-aortic lymph nodes suspected to be cervical cancer metastases. This intervention, originally oncologic, has discovered ectopic phaeochromocytoma a posteriori. The management of perioperative serious adverse events revealing the undiagnosed phaeochromocytoma is discussed.
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Affiliation(s)
- D Rousson
- Service d'anesthésie, centre hospitalier St-Joseph-St-Luc, 20, quai Claude-Bernard, 69007 Lyon, France.
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[Anaesthesia for endocrine tumor removal]. ACTA ACUST UNITED AC 2009; 28:549-63. [PMID: 19467826 DOI: 10.1016/j.annfar.2009.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 04/15/2009] [Indexed: 01/05/2023]
Abstract
Endocrine tumors could be defined by their ability to produce structural proteins or hormones common to nervous and endocrine cells. They might induce physiological transforms or outcome adverse events which should be well known in order to prevent or treat them early. The goal of this review was to describe these changes, to describe preoperative assessment, and to discuss intraoperative monitoring and drugs choice based on the literature from the last 30 years. As an example, it should be noticed that: (1) preoperative blood pressure control is essential to prepare phaeochromocytoma for surgery. It should be followed during anaesthesia by intensive fluid load, reversible anaesthetic drugs and rational cardiovascular medications use (as for example remifentanil, sevoflurane, calcium channel blockers and esmolol), and after surgery by narrow clinical and biological monitoring; (2) after medullar thyroid cancer, main adverse events include cervical compressive haematoma and recurrent laryngeal nerve injury as for any thyroid surgery; (3) during pituitary surgery, air embolism might be expected, whereas water dysregulation (diabetes insipidus), corticotroph insufficiency, cerebrospinal fluid (CSF) leak might occur postoperatively. In acromegaly, difficult endotracheal intubation is possible whereas severe Cushing's syndrome may be complicated with hypertensive cardiac failure, infections, thrombosis, delayed cicatrisation; (4) somatostatine analogs are a keystone in carcinoid tumors preoperative and anaesthetic management.
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Gosse P, Tauzin-Fin P, Sesay MB, Sautereau A, Ballanger P. Preparation for surgery of phaeochromocytoma by blockade of α-adrenergic receptors with urapidil: what dose? J Hum Hypertens 2009; 23:605-9. [DOI: 10.1038/jhh.2008.172] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kumazawa M, Iida H, Uchida M, Iida M, Takenaka M, Dohi S. The comparative effects of intravenous nicardipine and prostaglandin E1 on the cerebral pial arteriolar constriction seen after unclamping of an aortic cross-clamp in rabbits. Anesth Analg 2007; 104:659-65. [PMID: 17312226 DOI: 10.1213/01.ane.0000253493.76249.54] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The potent vasodilators nicardipine and prostaglandin E1 (PGE1) are useful for the treatment of systemic hypertension or pulmonary hypertension during aortic surgery. METHODS We measured cerebral pial arteriolar diameters, using a rabbit closed cranial window preparation: before (baseline) and 15 min after the start of an IV infusion (preclamp) (0.9% saline [control group], nicardipine [at 0.1, 1.0, or 10 microg x kg(-1) x min(-1)], or PGE1 [at 0.1 or 1.0 microg x kg(-1) x min(-1)]), just after aortic clamping, 20 min after clamping, and at 0-60 min after unclamping. RESULTS In the control group, a significant decrease in diameter persisted for at least 60 min after unclamping (maximum [at 60 min], -16% for large [> or =75 microm], and -27% for small [<75 microm] arterioles versus baseline). Although the aortic unclamping-induced vasoconstriction was unaffected under the smallest dose of nicardipine, it was significantly attenuated under larger doses in both large and small arterioles (residual vasoconstriction, -10% and -6% for large and -18% and -10% for small arterioles; at 60 min). The pial arteriolar constriction observed at 5 min or more after unclamping in the control group was not altered by PGE1 in either large or small arterioles. CONCLUSIONS The larger doses of nicardipine, but neither dose of PGE1, attenuated aortic unclamping-induced sustained cerebral pial arteriolar constriction.
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Affiliation(s)
- Masahiko Kumazawa
- Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu City, Gifu, Japan
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Seefelder C, Sparks JW, Chirnomas D, Diller L, Shamberger RC. Perioperative management of a child with severe hypertension from a catecholamine secreting neuroblastoma. Paediatr Anaesth 2005; 15:606-10. [PMID: 15960647 DOI: 10.1111/j.1460-9592.2005.01631.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Increased catecholamine secretion from neuroblastomas can occasionally be demonstrated, but severe hypertension is uncommon. We report the perioperative management of a 5 year old child with stage III adrenal neuroblastoma who presented with malignant hypertension and high norepinephrine and dopamine levels. Hypertensive crises occurred during anesthesia for surgical biopsy and during chemotherapy. After blood pressure control using phenoxybenzamine and enalapril, doxazosin was used successfully as the preoperative alpha-adrenergic receptor antagonist for surgical tumor resection.
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Affiliation(s)
- Christian Seefelder
- Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital, Boston, MA 02115, USA.
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Lacoste L. Préparation et environnement périopératoire dans la chirurgie du phéochromocytome. ACTA ACUST UNITED AC 2005; 130:264-6. [PMID: 15847865 DOI: 10.1016/j.anchir.2005.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- L Lacoste
- Département d'anesthésie-réanimation chirurgicale, centre hospitalier universitaire La Milétrie, 2, rue de la Milétrie, 86021 Poitiers cedex, France.
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Abstract
The basic principles of treatment for phaeochromocytomas and paragangliomas are to block the effects of high catecholamines and make the patient safe for surgical removal of the tumour. The traditional preoperative medical preparation uses the non-selective alpha-adrenoceptor blocker phenoxybenzamine and a beta-adrenoceptor blocker, propranolol. Other agents have been used effectively, including selective alpha-adrenoceptor blockers, doxazosin and prazosin, and calcium channel antagonists. There have been no trial comparing regimens and there is some controversy as to the best regimen. Major advances have been made in laparoscopic and laparoscopic-assisted surgery. Cortical-sparing adrenalectomy has been used in some centres for familial phaeochromocytomas. High-dose [(131)I]-metaiodobenzylguanidine therapy and combined [(131)I]-metaiodobenzylguanidine and chemotherapy are promising new developments for the malignant disease. All patients should be followed indefinitely because the recurrence or malignancy rate is >or= 10% over a prolonged follow up.
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Affiliation(s)
- Shern L Chew
- St Bartholomew's Hospital, London, EC1A 7BE, UK.
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Tauzin-Fin P, Sesay M, Gosse P, Ballanger P. Effects of perioperative alpha1 block on haemodynamic control during laparoscopic surgery for phaeochromocytoma. Br J Anaesth 2004; 92:512-7. [PMID: 14766711 DOI: 10.1093/bja/aeh083] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Laparoscopic surgery for phaeochromocytoma can cause excessive catechol amine release with severe hypertension and sinus tachycardia. i.v. calcium antagonists may be used to prevent increases in blood pressure during phaeochromocytoma resection. We investigated the effects of perioperative alpha(1) adrenergic block with urapidil on intraoperative haemodynamic events. The aim was to block the alpha(1) adrenergic receptors before any acute catecholamine release, to prevent any severe rise in blood pressure. METHODS Eighteen patients with a phaeochromocytoma received a continuous i.v. infusion of urapidil 10-15 mg h(-1) for 3 days before surgery and until the adrenal gland had been removed. Plasma catecholamine concentrations were measured before surgery, after induction of anaesthesia, at the end of pneumoperitoneal insufflation, during gland manipulation, after gland resection, and in the recovery room after extubation. Arterial pressure was recorded concomitantly. Hypertensive events were treated with boluses of nicardipine with or without esmolol. RESULTS All patients had the adrenal tumour removed without any severe rise in blood pressure or other complication. Creation of a pneumoperitoneum and adrenal gland manipulation induced significant catecholamine release associated with hypertension in 6 and 12 patients, respectively. No correlation was found between hypertensive events and plasma catecholamine levels suggesting alpha(1) receptor block with urapidil is efficacious. CONCLUSIONS Perioperative alpha(1) block using i.v. urapidil is a safe and efficient alternative during surgical management of phaeochromocytoma.
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Affiliation(s)
- P Tauzin-Fin
- Department of Anaesthesia, Pellegrin University Hospital, 33076 Bordeaux Cedex, France.
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Poopalalingam R, Chin EY. Rapid preparation of a patient with pheochromocytoma with labetolol and magnesium sulfate. Can J Anaesth 2001; 48:876-80. [PMID: 11606344 DOI: 10.1007/bf03017353] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To describe the rapid perioperative optimization and control of blood pressure in a young patient who presented with pheochromocytoma. He was non-compliant with phenoxybenzamine but insisted on early surgery. He was scheduled for laparoscopic resection of the tumour. CLINICAL FEATURES This 32-yr-old man presented with uncontrolled hypertension for a few years for which he was treated with nifedipine. He subsequently defaulted follow-up. The patient presented again approximately three months from the day of surgery and was diagnosed to have a pheochromocytoma. The endocrinologist prescribed phenoxybenzamine and propanolol in addition to the nifedipine but the patient stopped taking both drugs six weeks prior to surgery due to their side effects. The patient was admitted the evening before surgery to the intensive care unit for rapid control of his blood pressure. Blood pressure was optimized with an infusion of labetolol and volume expansion titrated under central venous catheter and intraarterial blood pressure guidance throughout the night. On the morning of surgery, a magnesium sulfate infusion was started. The laparoscopic surgery proceeded uneventfully and the patient was hemodynamically stable. There were two transient periods of hypotension after induction and at removal of tumour respectively which were corrected with a brief adrenaline infusion. No adverse outcome was noted. CONCLUSION This case highlights the possibility of a more rapid perioperative control of pheochromocytoma using high doses of labetolol and a magnesium sulfate infusion to achieve stable intraoperative hemodynamics during laparoscopic resection of pheochromocytoma.
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Affiliation(s)
- R Poopalalingam
- Department of Anaesthesia and Surgical Intensive Care, Singapore General Hospital, Singapore.
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Abstract
Adrenal-dependent hypertension syndromes are uncommon forms of hypertension. They include primary aldosteronism, pheochromocytoma, Cushing"s syndrome, and congenital adrenal hyperplasia. Pheochromocytomas are the cause of hypertension in 0.1% to 0.2% of hypertensive patients. Excess catecholamine release and other neural and humoral mechanisms contribute to the pathophysiology of hypertension. Patients with pheochromocytomas have a potentially curable cause of endocrine hypertension and, if undetected, pheochromocytomas confer a high risk for morbidity and mortality, especially during surgical procedures and pregnancy. All patients with incidental adrenal tumors, regardless of tumor size, should be biochemically screened for pheochromocytoma (especially before resection or needle biopsy) to avoid precipitation of a lethal hypertensive crisis.
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Affiliation(s)
- N N Hanna
- University of Kentucky Medical Center, 800 Rose Street, Lexington, KY 40515, USA
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