ANESTHETIC MANAGEMENT OF PHEOCHROMOCYTOMAS LAPAROSCOPIC ADRENALECTOMY: A 5-YEAR ANALYSIS OF THE APPLICATION EXPERIENCE
Keywords:
pheochromocytoma, anesthesia, staged perioperative hemodynamic management, urapidil, refortanAbstract
Aim. The introduction of modern pheochromocytoma anesthetic management in a specialized endocrinology center with using of the algorithm of staged perioperative hemodynamic monitoring. Materials and methods. The implementation of pheochromocytoma anesthetic management in 33 women during surgical intervention by video assistant laparoscopic adrenalectomy. All patients were used an algorithm of staged perioperative hemodynamic management (SPOHM): preoperative tableted hypotensive therapy before admission (outpatients); preoperative infusion controlled hypotensive therapy by urapidil and correction of hypovolemia by balanced crystalloid solutions and a 10 % solution of HES (200/0.5) were applied 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 final hypovolemia correction on the last 4th stage. Results and discussion. All patients had significantly (p<0.001) increased levels of daily urine metanephrines up to 1831.6±337.9 mg/24 h (control of 169.3± ±12.7 mg/24 h). According to SPOHM doxazosin 10.0±1.0 mg twice-daily or urapidil 144.0±11.2 mg twice-daily were used at the first stage. On the second stage performed hemodilution by 10 % solution of HES (200/0.5) and controlled infusion antihypertensive therapy by urapidil in anaverage speed 9.7±1.9 mg/hr. During the third stage infusion rate of Urapidil was 1.25±0.08 mg/min (additionaly, in time of the pheochromocytoma surgical separation, urapidil bolus was administered in dosages 25–50 mg i/v when the slightest increasing of blood pressure was detected). On the fourth stage was conducted the prevention of adrenal insufficiency and hypovolemia. Conclusions. The introduction of pheochromocytoma anesthetic management in a specialized endocrinological center has ensured high efficiency and safety of laparoscopic adrenalectomy under general anesthesia and an absence of lethal cases. EPOGM is effective, easily manageable and safe method of stabilization of hemodynamic markers during a preparation for surgery and adrenalectomy in pheochromocytoma patients.
References
Внутрішні хвороби : довідник : в 10 книгах / під ред. Є. Браунвальда [та ін.] ; ред.1–го вид. Т. Р. Харрісон. – М. : Медицина, 1992–1997. – 3430 с.
Pheochromocytoma Anesthetic Management / D. D. Kim, C. Matsui, J. L. Gozzani, L. A. S. T. Mathias // Open J Anesthesiol. – 2013. – Vol. 3, N 3. – P. 152–155.
Pheochromocytoma / L. Fernández–Cruz, M. Puig–Domingo, I. Halperin, G. Sesmilo // Scand J Surg. – 2004. – Vol. 93, N 4. – P. 302–309.
The North American Neuroendocrine Tumor Society Consensus Guideline for the Diagnosis and Management of Neuroendocrine Tumors: Pheochromocytoma, Paraganglioma, and Medullary Thyroid Cancer / H. Chen, R. S. Sippel, M. S. O’Dorisio [et al.] // Pancreas. – 2010. – Vol. 39, N 6. – Р. 775–783.
Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline / J. W. Lenders, Q. Y. Duh, G. Eisenhofer [et al.] // J Clin Endocrinol Metab. – 2014. – Vol. 99, N 6. – P. 1915–1942.
Анестезіологічний менеджмент феохромоцитом в умовах спеціалізованого ендокринологічного центру / С. М. Черенько, С. О. Дубров, М. В. Кунатовський [та ін.] // Міжнародний ендокринологічний журнал. – 2016. – № 2 (74). – С. 115–123.
Bajwa S. S. Implications and Considerations during Pheochromocytoma Resection: A Challenge to the Anesthesiologist / S. S. Bajwa, S. K. Bajwa // Indian J Endocrinol Metab. – 2011. – Vol. 15. – Suppl. 4. – Р. S337–S344.
Adverse Drug Reactions inPatients with Phaeochromocytoma: Incidence, Prevention and Management / G. Eisenhofer, G. Rivers, A. L. Rosas [et al.] // Drug Safety. – 2007. – Vol. 30, N 11. – Р. 1031–1062.
Kinney M. A. Perioperative Management of Pheochromocytoma / M. A. Kinney, B. J. Narr, M. A. Warner // J Cardiothorac Vasc Anesth. – 2002. – Vol. 16, N 3. – Р. 359–369.
Urapidil in the preoperative treatment of pheochromocytomas: a safe and cost–effective method / N. Habbe, F. Ruger, J. Bojunga [et al.] // World J. Surg. – 2013. – Vol. 37, N 5. – P. 1141–1146.
Use of urapidil during surgery for pheochromocytoma / A. Steib, F. Collin, N. Stojeba [et al.] // Ann. Fr. Anesth. Reanim. – 1996. – Vol. 15, N 2. – P. 142–148.
Кунатовський М. В. Передопераційна медикаментозна підготовка α-адреноблокаторами як невід’ємна складова періопераційного анестезіологічного менеджменту лапароскопічних адреналектомій при феохромоцитомі / М. В. Кунатовський // Клінічна ендокринологія та ендокринна хірургія. – 2016. – № 2. – С. 74–84.
Диагностика и лечение феохромоцитомы / О. Н. Садриев, А. Д. Гаибов, Ш. С. Анварова, У. М. Авгонов // Кардиология и сердечно-сосудистая хирургия. – 2014. – № 5. – С. 52–56.
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.
Профілактика венозних тромбоемболічних ускладнень у пацієнтів у торакальній хірургії / С. О. Дубров, Ф. С. Глумчер, О. О. Гавриленко [та ін.] // Досягнення біології та медицини. – 2012. – № 1 (19). – С. 43–46.
