Main Article Content
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.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our edition uses the copyright terms of Creative Commons for open access journals.
Authors, who are published in this journal, agree with the following terms:
- The authors retain rights for authorship of their article and grant to the edition the right of first publication of the article on a Creative Commons Attribution 4.0 International License, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
- Directing the article for the publication to the editorial board (publisher), the author agrees with transmitting of rights for the protection and using the article, including parts of the article, which are protected by the copyrights, such as the author’s photo, pictures, charts, tables, etc., including the reproduction in the media and the Internet; for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.
- The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.
- The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.
- The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.
- The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.
Chen H., Sippel R.S., O’Dorisio M.S., Vinik A.I., Lloyd R.V., Pacak K. North American Neuroendocrine Tumor Society (NANETS). The North American Neuroendocrine Tumor Society Consensus Guideline for the Diagnosis and Management of Neuroendocrine Tumors: Pheochromocytoma, Paraganglioma, and Medullary Thyroid Cancer // Pancreas. — 2010. — Vol. 39. — Р. 775-783.
Pacak K., Eisenhofer G., Ahlman H., Bornstein S.R., Gimenez-Roqueplo A.P., Grossman A.B., Kimura N., Mannelli M., McNicol A.M. and Tischler A.S. International Symposium on Pheochromocytoma. Pheochromocytoma: Recommendations for Clinical Practice from the First International Symposium. October 2005 // Nature Clinical Practice Endocrinology & Metabolism. 2007. — Vol. 3. — Р. 92-102.
Young W.F. Williams Textbook of Endocrinology. — Philadelphia: Saunders Elsevier, 2008.
Lenders J.W., Eisenhofer G., Mannelli M., Pacak K. Phaeochromocytoma // Lancet. — 2005. — Vol. 20–26, № 366. — Р. 665-675.
Bajwa S.S., Bajwa S.K. Implications and Considerations during Pheochromocytoma Resection: A Challenge to the Anesthesiologist // Indian Journal of Endocrinology & Metabolism. — 2011. — Vol. 15, № S4. — Р. S337-S344.
Eisenhofer G., Rivers G., Rosas A.L., Quezado Z., Manger W.M. and Pacak K. Adverse Drug Reactions in Patients with Phaeochromocytoma: Incidence, Prevention and Management // Drug Safety. — 2007. — Vol. 30. — Р. 1031-1062.
Kinney M.A., Narr B.J., Warner M.A. Perioperative Management of Pheochromocytoma // Journal of Cardiothoracic and Vascular Anesthesia. — 2002. — Vol. 16. — Р. 359-369.
Habbe N., Ruger F., Bojunga J., Bechstein W.O., Holzer K. Urapidil in the preoperative treatment of pheochromocytomas: a safe and cost-effective method // World J. Surg. — 2013 May. — 37(5). — 1141-6.
Steib A., Collin F., Stojeba N., Coron T., Weber J.C., Beller J.P. Use of urapidil during surgery for pheochromocytoma // Ann. Fr. Anesth. Reanim. — 1996. — 15(2). — 142-8.
Pacak K. Preoperative Management of the Pheochromocytoma Patient // Indian Journal of Endocrinology & Metabolism. — 2007. — Vol. 92. — Р. 4069-4079.
Lentschener C., Gaujoux S., Tesniere A. and Dousset B. Point of Controversy: Perioperative Care of Patients Undergoing Pheochromocytoma Removal-Time for a Reappraisal? // European Journal of Endocrinology. — 2011. — Vol. 165. — Р. 365-373.
Wall R.T. Stoelting’s Anesthesia and Co-Existing Disease. — Philadelphia: Saunders Elsevier, 2008.
Jugovac І., Antapli M., Markan S. Anesthesia and Pheochromocytoma // International Anesthesiology Clinics. — 2011. — Vol. 49. — Р. 57-61.
Westfall T.C., Westfall D.P. The Pharmacologycal Basis of Therapeutics. — New York: McGraw Hill, 2011.
Bruynzeel H., Feelders R.A., Groenland T.H., vanden Meiracker A.H., van Eijck C.H., Lange J.F., de Herder W.W., Kazemier G. Risk Factors for Hemodynamic Instability during Surgery for Pheochromocytoma // Journal of Clinical Endocrinology & Metabolism. — 2010. — Vol. 95. — Р. 678-685.
Nizamoğlu A., Salihoğlu Z., Bolayrl M. Effects of Epidural-and-General Anesthesia Combined versus General Anesthesia during Laparoscopic Adrenalectomy // Surgical Laparoscopy Endoscopy & Percutaneous Techniques. — 2011. — Vol. 21. — Р. 372-379.
Isosu T., Obara S., Ohashi S., Hosono A., Nakano Y., Imaizumi T., Mogami M., Iida H., Murakawa M. Examination of the Usefulness of Non-Invasive Stroke Volume Variation Monitoring for Adjusting Fluid Supplementation during Laparoscopic Adrenalectomy in Patients with Pheochromocytoma // Fukushima Journal of Medical Science. — 2012. — Vol. 58. — Р. 78-81.
Domia R., Sulaa H. Pheochromocytoma, the Challenge to Anesthesiologists // Journal of Endocrinology & Metabolism. — 2011. — Vol. 1. — Р. 97-100.
Kinney M.A., Warner M.E., van Heerden J.A., Horlocker T.T., Young W.F. Jr, Schroeder D.R., Maxson P.M., Warner M.A. Perianesthetic Risks and Outcomes of Pheochromocytoma and Paraganglioma Resection // Anesthesia & Analgesia. — 2000. — Vol. 91. — Р. 1118-1123.
James M.F., Cronjé L. Pheochromocytoma Crisis: The Use of Magnesium Sulfate // Anesthesia & Analgesia. — 2004. — Vol. 99. — Р. 680-686.
Herroeder S., Schönherr M.E., De Hert S.G., Hollmann M.W. Magnesium — Essentials for Anesthesiologists // Anesthesiology. — 2011. — Vol. 114. — Р. 971-993.
Lord M.S., Augoustides J.G. Perioperative Management of Pheochromocytoma: Focus on Magnesium, Clevidipine, and Vasopressin // Journal of Cardiothoracic and Vascular Anesthesia. — 2012. — Vol. 26. — Р. 526-531.
Van der Horst-Schrivers A.N., Kerstens M.N., Wolffenbuttel B.H. Preoperative Pharmacological Management of Phaeochromocytoma // Netherlands Journal of Medicine. — 2006. — Vol. 64. — Р. 290-295.
Guillemot J., Compagnon P., Cartier D., Thouennon E., Bastard C., Lihrmann I., Pichon P., Thuillez C., Plouin P.F., Bertherat J., Anouar Y., Kuhn J.M., Yon L., Lefebvre H. Metoclopramide stimulates catecholamine- and granin-derived peptide secretion from pheochromocytoma cells through activation of serotonin type 4 (5-HT4) receptors // Endocr. Relat Cancer. — 2009 Mar. — 16(1). — 281-90. doi: 10.1677/ERC‑08-0190. Epub 2008 Oct 23.
Daniel D. Kim, Christiano Matsui, Judymara L. Gozzani, Ligia A.S.T. Mathias. Pheochromocytoma Anesthetic Management // Open Journal of Anesthesiology. — 2013. — 3. — 152-155.
Інструкція з медичного застосування препарату Рефортан плюс 10 %, Р.П. № UA/6680/01/01 від от 28.09.2012. Наказ МОЗ № 755 від 28.09.2012.
Дубров С.О., Глумчер Ф.С., Гавриленко О.О., Тарасенко С.О., Сем’янків А.М. Профілактика венозних тромбоемболічних ускладнень у пацієнтів у торакальній хірургії / // Досягнення біології та медицини. — 2012. — № 1(19). — С. 43-46.