Pheochromocytoma: Hemodynamic Control Features During Laparoscopic Adrenalectomy

Aim: 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 anesthetic management was implemented in 33 women with pheochromocytoma during surgical removal by video-assisted laparoscopic adrenalectomy. In all patients we have used an algorithm of staged perioperative hemodynamic management (SPOHM): preoperative tableted 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 hydroxiethyl 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. 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 of 169.3 ± 12.7 mg/24 h). According to developed SPOHM algorithm, doxazosin 10.0 ± 1.0 mg or urapidil 144.0 ± 11.2 mg were used twice daily at the first stage. On the second stage, we have performed hemodilution by 10% solution of HES (200/0.5) and controlled infusion antihypertensive therapy by urapidil in an average speed 9.7 ± 1.9 mg/hr. During the third stage, infusion rate of urapidil was 1.25 ± 0.08 mg/min intraoperatively (additionaly, during the surgical removal of pheochromocytoma, urapidil 25–50 mg i/v bolus was administered even if the slightest increase of blood pressure was detected). On the fourth stage, there was conducted the prevention of adrenal insufficiency and hypovolemia. Conclusions. The introduction of anesthetic management of patients with pheochromocytoma in a specialized endocrinological center has provided a high efficiency and safety of laparoscopic adrenalectomy under general anesthesia. EPOGM is effective, easily manageable and safe method for the stabilization of hemodynamic markers in the preparation for surgery and during surgical intervention. There were no deaths.