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 83
- Downloads 0
Рharmacogenetic Aspects of Metformin Action in Patients with Type 2 Diabetes Mellitus
Type 2 diabetes mellitus (T2DM) is a slowly-progressive polygenic metabolic disorder resulting from ineffective insulin cascading in the body. The goals of the treatment strategies for T2DM are to minimize long-term micr...
Current European Guidelines on the Management of Chronic Hypoparathyroidism in Adults According to the Materials of the 17th Congress of the European Society of Endocrinology, Dublin, Ireland, 16–20 May 2015
European Society of Endocrinology clinical guidelines on hypoparathyroidism was approved by European Congress of Endocrinology (May 2015) and was published in the European Journal of Endocrinology in June 2015. The autho...
Diagnosis and Treatment of Polycystic Ovary Syndrome in Pediatric Gynaecology
Diagnosis of polycystic ovary syndrome (PCOS) in adolescence still raises many questions. The problem is that the characteristics of normal puberty often coincide with PCOS symptoms, so a number of researchers suggest to...
Diabetes Mellitus Type 2: How to Avoid Errors and to Increase the Effectiveness of Rreatment
The article considers the urgency of the problem of diabetes mellitus incidence (DM) in the world today. It is emphasized that at the present stage of development of diabetology main goal of DM treatment is to achieve bl...
Using the ABC-Analysis for Efficient Costs Planning for Pharmacotherapy with Oral Hypoglycemic Drugs
The article reflects the results of ABC - analysis for rational planning of costs for drug treatment of oral hypoglycemic drugs.