Preoperative and Operative Management of Patients With Phaeochromocytoma

Ross, E. J.; Prichard, B. N. C.; Kaufman, Léon; Robertson, AG; Harries, Bethan

doi:10.1097/00132586-196710000-00006

Cited by 23 publications

(46 citation statements)

References 10 publications

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“…In early studies, life-threatening intraoperative catecholamine release has been quickly identified as the cause of increased blood pressure, various cardiac arrhythmias including ventricular tachycardia and fibrillation, left ventricular failures, myocardial ischemias, and strokes following induction of anesthesia or tumor manipulation (13,14). Prolonged postoperative hypotension followed the abrupt withdrawal of circulating catecholamines associated with tumor removal and accounted for most operative deaths (15).…”

Section: Historical Backgroundmentioning

confidence: 99%

“…Prolonged postoperative hypotension followed the abrupt withdrawal of circulating catecholamines associated with tumor removal and accounted for most operative deaths (15). Pheochromocytoma removals were associated with a mortality rate of 20-45% in first reports (13,14). Prolonged high preoperative levels of circulating vasopressors released from pheochromocytomas were assumed to cause a vasoconstriction, leading to arterial hypertension and a chronic decrease in blood volume (13)(14)(15).…”

Section: Historical Backgroundmentioning

confidence: 99%

“…Pheochromocytoma removals were associated with a mortality rate of 20-45% in first reports (13,14). Prolonged high preoperative levels of circulating vasopressors released from pheochromocytomas were assumed to cause a vasoconstriction, leading to arterial hypertension and a chronic decrease in blood volume (13)(14)(15). The subsequent sudden intraoperative withdrawal of vasopressors following pheochromocytoma resection was believed to cause abrupt relaxation of the vascular bed, in turn resulting in hypotension and shock unless the reduced blood volume was restored (13)(14)(15).…”

Section: Historical Backgroundmentioning

confidence: 99%

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Point of controversy: perioperative care of patients undergoing pheochromocytoma removal–time for a reappraisal?

Lentschener¹,

Gaujoux²,

Tesnière³

et al. 2011

European Journal of Endocrinology

126

143

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Adrenalectomy for pheochromocytoma is reported with a mortality close to zero in recent studies. The dogma of preoperative fluid and hypotensive drug administrations is widely applied in patients scheduled for pheochromocytoma removal and is assumed to have a beneficial effect on operative outcomes. This paradigm is only based on historical studies of non-standardized practices and criteria for efficacy, with no control group. Pre-and intraoperative hypovolemia have never been demonstrated in patients scheduled for pheochromocytoma removal. Recent improvements in outcome of patients undergoing adrenalectomy for pheochromocytoma could also be the result of improvement in surgical techniques and refinement in anesthetic practices. Whether better knowledge of the disease, efficiency of available intravenous short-acting vasoactive drugs, and careful intraoperative handling of the tumor make it possible to omit preoperative preparation in most patients scheduled for pheochromocytoma removal is presently questionable. We reviewed available literature in this respect.

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Section: Historical Backgroundmentioning

confidence: 99%

Section: Historical Backgroundmentioning

confidence: 99%

Section: Historical Backgroundmentioning

confidence: 99%

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Point of controversy: perioperative care of patients undergoing pheochromocytoma removal–time for a reappraisal?

Lentschener¹,

Gaujoux²,

Tesnière³

et al. 2011

European Journal of Endocrinology

126

143

View full text Add to dashboard Cite

show abstract

“…~,2,5 If vasopressors become necessary, most authors recommend the continuous infusion of L-norepinephrine (4 mg/500 ml). 1,8,5 This latter measure is only temporarily necessary in most cases, provided adequate fuid replacement has been achieved.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management of pheochromocytoma: A case report

Fanning¹,

Dykes²,

May³

1970

Can. Anaesth. Soc. J.

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THE ANAESTHETIC MANAGEMENT Of patients with pheochromocytoma has become increasingly sophisticated in recent years, thanks to the introduction of a variety of drugs which allow selective inhibition of responses to abnormally high levels of circulating catecholamines. Preoperative and intraoperative alpha and beta adrenergic block, improved intraoperative monitoring, fluid and blood infusion therapy, and employment of anaesthetic agents which do not sensitize the myocardium to circulating catecholamines have all contributed to reducing the dangers of uncontrollable hypertension and serious cardiac arrhythmias during removal of these tumours.The following ease report describes our recent experience with a patient with pheochromocytoma and illustrates the principles of management advocated in the current medical literature. CASE l~voaxA 43-year-old woman was referred to the University of Rochester Medical Center with a presumptive diagnosis of pheochromocytoma. Though intermittently hypertensive for ten years, she had become persistently hypertensive during the year prior to admission. Additional symptoms included nervousness, increased perspiration, episodes of palpitations, decreased vision in the right eye, slight weight loss, and one episode of "vascular headache." Further history revealed that the patient's mother had suffered from hypertension and a "stroke," and two of her sisters were said to be suffering from hypertension. Physical examination revealed a well-developed, alert, co-operative white female, whose blood pressure was 200,/125 mm Hg and pulse rate 72 beats per minute. The maximum recorded blood pressure preoperatively was 250/160 mm Hg. Other physical findings included a fine tremor of the outstretched hands, bilateral retinopathy with papilloedema, and a right upper quadrant abdominal mass. No Cushingoid features were present.Laboratory findings. The admission haemogram (haematocrit 39 per cent), blood urea nitrogen, serum electrolytes, serum glutamic oxalacetic transaminase, and alkaline phosphatase levels were within normal limits. The fasting blood sugar level was 169 mg per 100 ml, and the glucose tolerance test levels were elevated.

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“…Präoperativ ist eine Alpharezeptorblockade angezeigt, um perioperative kardiovaskuläre Komplikationen zu minimieren [5,7] Im Kapitel "Direkte orale Antikoagulanzien bei Adipositas" des Beitrags war der Abschnitt zur Dosisreduktion auf S. 41 in Bezug auf die eGFR teilweise nicht korrekt. Richtig muss es heißen: Die Nierenfunktion ist für die korrekte Anwendung der DOAK von größter Bedeutung und sollte regelmäßig während der Therapie kontrolliert werden.…”

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Erratum zu: Antikoagulation des adipösen Patienten

Chobanyan-Jürgens

Engeli

May

2017

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Preoperative and Operative Management of Patients With Phaeochromocytoma

Cited by 23 publications

References 10 publications

Point of controversy: perioperative care of patients undergoing pheochromocytoma removal–time for a reappraisal?

Point of controversy: perioperative care of patients undergoing pheochromocytoma removal–time for a reappraisal?

Anaesthetic management of pheochromocytoma: A case report

Erratum zu: Antikoagulation des adipösen Patienten

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