Anesthetic Management of Pheochromocytomas in a Specialized Endocrinology Center

Abstract

bjective: the introduction of modern anesthetic management of patients with pheochromocytoma in a specialized endocrinology center using the algorithm of staged perioperative hemodynamic monitoring. Materials and methods. The implementation of anesthetic management has been carried out in 33 women with adrenal pheochromocytomas during their surgical removal by means of video-assisted laparoscopic adrenalectomy. In all patients, we have used an algorithm of staged perioperative hemodynamic management (SPOHM): preoperative tablet hypotensive therapy before admission to the hospital; preoperative infusion controlled hypotensive therapy by urapidil and correction of hypovolemia by balanced crystalloid solutions and a 10% solution of hydroxyethyl starch (HES) (200/0.5) on the 2nd stage; intraoperative infusion controlled antihypertensive therapy by urapidil on the 3rd stage under the control of invasive and non-invasive hemodynamic monitoring and prevention of adrenal insufficiency and hypovolemia correction on the 4th stage. Results and discussion. All patients had significantly (p < 0.001) increased levels of daily urine metanephrines up to 1,831.6 ± 337.9 mg/24 h (control 169.3 ± 12.7 mg/24 h). According to the developed SPOHM algorithm, doxazosin at a dose of 10.0 ± 1.0 mg or urapidil at a dose of 144.0 ± 11.2 mg were used twice daily in the first stage. On the second stage, hemodilution by 10 % solution of HES (200/0.5) and controlled infusion antihypertensive therapy by urapidil with an average rate of 9.7 ± 1.9 mg/hr were performed. In the third stage, intraoperatively the rate of urapidil infusion was 1.25 ± 0.08 mg/min (additionally, during surgical removal of adrenal gland with pheochromocytoma, urapidil bolus 25–50 mg i/v was administered even when the slightest increase of blood pressure was detected). On the fourth stage, the prevention of adrenal insufficiency and hypovolemia was conducted. Conclusions. The introduction of anesthetic management of patients with pheochromocytoma in a specialized endocrinology center has ensured the high efficiency and safety of laparoscopic adrenalectomy under general anesthesia and the absence of lethal cases. SPOHM in preparation for the surgery and during surgical intervention is an effective, easily manageable and safe method for stabilization of hemodynamic markers in pheochromocytoma patients during adrenalectomy.

Keywords

• pheochromocytoma
• anesthesia
• staged perioperative hemodynamic management
• urapidil
• refortan.