Hemodynamic Changes and Catecholamine Release During Laparoscopic Adrenalectomy for Pheochromocytoma
- 1 January 1999
- journal article
- clinical trial
- Published by Wolters Kluwer Health in Anesthesia & Analgesia
- Vol. 88 (1) , 16-21
- https://doi.org/10.1097/00000539-199901000-00004
Abstract
We investigated hemodynamics and plasma catecholamine concentrations in eight consecutive patients undergoing laparoscopic adrenalectomy for suspected pheochromocytoma. The same anesthesia protocol was used in all patients: a continuous infusion of sufentanil 0.5 microg x kg(-1) x h(-1) and isoflurane 0.4% (end-tidal) in 50% N2O/O2. Systolic arterial pressure was maintained between 120 and 160 mm Hg by adjusting an infusion of nicardipine, a calcium-channel blocker, while tachycardia (>100 bpm) was treated by 1-mg boluses of atenolol. Hemodynamics (thermodilution technique) and plasma catecholamine concentrations were measured before surgery, after the induction of anesthesia, after turning the patient to the lateral position, during pneumoperitoneum, during tumor manipulation, after adrenalectomy, and at the end of surgery. Two events resulted in significant catecholamine release: creation of the pneumoperitoneum and adrenal gland manipulation. As a consequence, a twofold increase in cardiac output was recorded. Adjustments of nicardipine infusion (2-6 microg x kg(-1) x min(-1)) minimized changes in mean arterial pressure. Beta-adrenergic blockade was necessary in six patients. In conclusion, laparoscopic adrenalectomy for pheochromocytoma results in marked catecholamine release during pneumoperitoneum and tumor manipulation. Titration of a nicardipine infusion allowed easy and quick control of the hemodynamic aberrancies related to these processes. Pneumoperitoneum during laparoscopy, now used for adrenalectomy, may complicate anesthetic management of patients with pheochromocytoma. In this study, laparoscopic adrenalectomy was associated with catecholamine release during the creation of pneumoperitoneum and tumor manipulation. Adjustments of a nicardipine infusion readily attenuated the subsequent hemodynamic aberrancies.Keywords
This publication has 17 references indexed in Scilit:
- Hemodynamic changes induced by laparoscopy and their endocrine correlates: effects of clonidineJournal of the American College of Cardiology, 1998
- Use of laparoscopic techniques improves outcome from adrenalectomyThe American Journal of Surgery, 1997
- Hormonal responses and cardiac filling pressures in head-up or head-down position and pneumoperitoneum in patients undergoing operative laparoscopyBritish Journal of Anaesthesia, 1997
- Questionability of the benefits of routine laparotomy as the surgical approach for pheochromocytomas and abdominal paragangliomasSurgery, 1996
- Is laparoscopic adrenalectomy indicated for pheochromocytomas?Surgery, 1996
- Adrenalectomy in the era of laparoscopySurgery, 1996
- Laparoscopic removal of pheochromocytomaSurgical Endoscopy, 1995
- Influence of Chronic Angiotensin-converting Enzyme Inhibition on Anesthetic InductionAnesthesiology, 1994
- Hemodynamic Changes During Laparoscopic CholecystectomyAnesthesia & Analgesia, 1993
- PhaeochromocytomaClinics in Endocrinology and Metabolism, 1977