Anesthetic Management of Pheochromocytomas in a Specialized Endocrinology Center
Journal Title: Міжнародний ендокринологічний журнал - Year 2016, Vol 2, Issue 74
Abstract
Objective: 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 implementation of anesthetic management has been carried out in 33 women with adrenal pheochromocytomas during their surgical removal by means of video-assisted laparoscopic adrenalectomy. In all patients, we have used an algorithm of staged perioperative hemodynamic management (SPOHM): preoperative tablet 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 hydroxyethyl 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 on the 4th stage. 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 169.3 ± 12.7 mg/24 h). According to the developed SPOHM algorithm, doxazosin at a dose of 10.0 ± 1.0 mg or urapidil at a dose of 144.0 ± 11.2 mg were used twice daily in the first stage. On the second stage, hemodilution by 10 % solution of HES (200/0.5) and controlled infusion antihypertensive therapy by urapidil with an average rate of 9.7 ± 1.9 mg/hr were performed. In the third stage, intraoperatively the rate of urapidil infusion was 1.25 ± 0.08 mg/min (additionally, during surgical removal of adrenal gland with pheochromocytoma, urapidil bolus 25–50 mg i/v was administered even when the slightest increase of blood pressure was detected). On the fourth stage, the prevention of adrenal insufficiency and hypovolemia was conducted. Conclusions. The introduction of anesthetic management of patients with pheochromocytoma in a specialized endocrinology center has ensured the high efficiency and safety of laparoscopic adrenalectomy under general anesthesia and the absence of lethal cases. SPOHM in preparation for the surgery and during surgical intervention is an effective, easily manageable and safe method for stabilization of hemodynamic markers in pheochromocytoma patients during adrenalectomy.
Authors and Affiliations
S. М. Cherenko, S. O. Dubrov, M. V. Kunatovskyi, O. A. Tovkai
Keywords
Related Articles
- EP ID EP206894
- DOI -
- Views 101
- Downloads 0
Blood glucose level and insulin resistance in patients with type 2 diabetic mellitus, diabetic retinopathy and obesity
Background. Diabetic retinopathy is the main cause of visual disorders in the world. The purpose of our work was to study the level of glycaemia and insulin resistance in patients with type 2 diabetes mellitus (DM), diab...
Child’s Intellect and Iodine Deficiency: Mechanisms of Negative Impact and Ways of Prevention
The paper presents a review of scientific literature on the effect of iodine deficiency on the intellectual development of the child. The conclusion was made about the need for a mass iodine prophylaxis in the population...
Hypothyroidism and Nonthyroidal Somatic Diseases in Adolescents
The structure and correlation of thyroid dysfunction and non-thyroid pathology in adolescents was analyzed. An adequate replacement therapy of hypothyroidism, which aims to compensate its manifestations, will not only im...
The Level and Structure of Primary Disability due to Diabetes Mellitus Among Young People
The state of the primary disability (levels, structure, regional characteristics, causes) in diabetes mellitus among young people in Ukraine was studied. Statistical data from centers and medical and social assessment in...
Features of Menstrual Disorders in Obese Women and Ways for Their Correction Using Orlistat
The research deals with the problem of reproductive health in women with obesity. In obese women, oligomenorrhea (in 62.2 % of examines patients) prevails in the structure of menstrual disorders. On the background of obe...