Effects of perioperative α 1 block on haemodynamic control during laparoscopic surgery for phaeochromocytoma

Tauzin-Fin, P.; Sesay, Musa; Gosse, Philippe; Ballanger, P.

doi:10.1093/bja/aeh083

Cited by 121 publications

(84 citation statements)

References 27 publications

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“…In our earlier study with low doses of urapidil, the incidence of hypertensive episodes during tumour resection was 66%. 7 Assuming that it would decrease to 56% with high doses, 18 patients in each group were required for the paired t-test with a ¼ 0.05, b ¼ 0.1 (power: 90%) and standard deviation ¼ 12%. Categorical data were compared using w 2 and Fisher's exact tests where appropriate.…”

Section: Discussionmentioning

confidence: 99%

“…7 Briefly, after radial artery cannulation, general anaesthesia was induced using i.v. propofol 2 mg kg Àl and sufentanil 0.8 mg kg…”

Section: Anaesthesia and Surgerymentioning

confidence: 99%

“…This agent is thus well suited for pre-operative preparation, enabling rapid adaptation to haemodynamic variations with a short weaning period, thus reducing the risk of post-operative hypotension. 6,7 We compared in a consecutive and prospective manner the interest of an arbitrary and usual dose of this agent to the maximum dose tolerated by the patient in preparation to resection of a phaeochromocytoma.…”

Section: Introductionmentioning

confidence: 99%

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Preparation for surgery of phaeochromocytoma by blockade of α-adrenergic receptors with urapidil: what dose?

Gosse

Tauzin-Fin

et al. 2009

J Hum Hypertens

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The preparation for phaeochromocytoma surgery is a matter of debate. Pre-operative blockade of a-1 receptors is increasingly employed in an attempt to reduce the risk of hypertensive episodes, especially during manipulation of the tumour. In this study, we compared the interest of an almost complete blockade of these receptors by high doses of urapidil in comparison with that of moderate doses of this drug. The study was conducted in two consecutive series of 18 patients, the first treated by a moderate dose, and the second by the highest dose tolerated by the patient. The two groups were comparable in other respects. All patients were operated under laparoscopy by the same surgeon and managed by the same anaesthetist using the same protocol. The number of hypertensive peaks was significantly reduced using the high dose of urapidil, with no more hypotensive episodes after tumour removal in this group. The area under the curve of norepinephrine levels as a function of time was significantly larger with the high doses of urapidil, arguing in favour of a more complete blockade of a-1 receptors. Our findings indicate the value of aggressive blockade of a-1 receptors in preparation for surgery of phaeochromocytoma.

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Section: Discussionmentioning

confidence: 99%

“…7 Briefly, after radial artery cannulation, general anaesthesia was induced using i.v. propofol 2 mg kg Àl and sufentanil 0.8 mg kg…”

Section: Anaesthesia and Surgerymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preparation for surgery of phaeochromocytoma by blockade of α-adrenergic receptors with urapidil: what dose?

Gosse

Tauzin-Fin

et al. 2009

J Hum Hypertens

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“…An alternative to calcium channel blockers could be the use of alpha-1 blockers, particularly the short acting agent urapidil, which is characterised by antiserotoninergic properties that block reflex tachycardia in response to a decrease in arterial pressure. Its peri-operative haemodynamic control has been evaluated in 18 patients undergoing laparoscopic phaeochromocytoma resection [10]. In that study, a continuous i.v.…”

Section: Discussionmentioning

confidence: 99%

The effect of calcium channel blockers on outcome following the surgical treatment of phaeochromocytomas and paragangliomas

Lebuffe¹,

Dosseh

Tek³

et al. 2005

Anaesthesia

125

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SummaryThe peri-operative management of patients undergoing surgery for phaeochromocytoma or paraganglioma with calcium channel blockers (CCB) and their impact on postoperative morbidity and mortality were studied. The medical records of 105 patients undergoing surgery between 1991 and 2002 were analysed retrospectively. In all patients, the calcium channel blocker nicardipine was used for the peri-operative management of haemodynamic changes. Sixty-five patients (61.9%) showed transient intra-operative hypertension. Systolic blood pressure (SBP) > 220 mmHg and SBP > 180 mmHg for > 10 consecutive minutes was observed in 14 (13%) and four patients (2.8%), respectively. SBP < 80 mmHg for > 10 consecutive minutes occurred in 13 patients (12.3%). Eleven patients (10.4%) developed postoperative complications and three patients died (2.8%). The median (range) ICU and hospital length of stay were, respectively, 1 (0-7) day and 10 (2-35) days. The sole use of calcium channel blockers for the peri-operative management of phaeochromocytoma and paraganglioma resection does not prevent all haemodynamic changes; however, its use was associated with a low morbidity and mortality.

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“…A study by Parnaby et al showed that laparoscopic adrenalectomy for pheochromocytoma was indeed associated with increased episodes of severe intraoperative hypertension (SBP >200-220 mmHg) when compared to the laparoscopic resection of other adrenal tumors (47). Interestingly, a creation of peritoneum has been shown to increase catecholamines release which may result in hemodynamic instability (35,48,49). Moreover, case control studies confirmed that in terms of hemodynamic instability laparoscopic approach is equal to open procedure (50,51).…”

Section: Intraoperative Considerationsmentioning

confidence: 99%

Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

Pisarska¹,

Pędziwiatr²,

Budzyński³

2016

Gland Surg.

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Effects of perioperative α 1 block on haemodynamic control during laparoscopic surgery for phaeochromocytoma

Abstract: Perioperative alpha(1) block using i.v. urapidil is a safe and efficient alternative during surgical management of phaeochromocytoma.

Cited by 121 publications

References 27 publications

Preparation for surgery of phaeochromocytoma by blockade of α-adrenergic receptors with urapidil: what dose?

Preparation for surgery of phaeochromocytoma by blockade of α-adrenergic receptors with urapidil: what dose?

The effect of calcium channel blockers on outcome following the surgical treatment of phaeochromocytomas and paragangliomas

Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma

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