Endocrine Abstracts

Background: Abrupt catecholamine release may cause paroxysmal attacks in patients with pheochromocytoma, and is associated with major hemodynamic changes during adrenalectomy. We investigated whether preoperative paroxysmal attacks are associated with further intraoperative adverse hemodynamic changes during adrenalectomy for pheochromocytoma.

Material and methods: From 1994 to 2006, 88 patients underwent laparoscopic adrenalectomy for pheochromocytoma. In our institution patients are scheduled when normotensiv, and do not receive consistently preoperatively hypotensive drugs unless these drugs have been prescribed elsewhere. Surgery was conducted under standard propofol, sufentanil, tracrium anaesthesia. An arterial line was inserted for arterial pressure (AP) monitoring. Esmolol was administered when heart rate was above 120 mmHg, Nicardipine when systolic AP (SAP) was above 150 mmHg, and Norepinephrine when SAP was <90 mmHg after tumour removal. Paroxysmal attacks were defined as paroxysmal palpitations or elevated heart rate, sweating, flushing, headaches, nausea, or hypertensive access. Whether preoperative paroxysms were associated with esmolol, nicardipine, norepinephrine administration and postoperative morbidity was investigated. χ², Mann–Whitney and t-tests were used.

Results: Patients of both groups did not differ with respect to demographic data, preoperative hypotensive treatment, intraoperative increased SAP, intraoperative nicardipine, esmolol or norepinephrine use or postoperative morbidity.

Conclusion: Preoperative paroxysms were not predictive of intraoperative hemodynamic changes, thus confirming that there is no evidence-based factors likely to predict intra and postoperative hemodynamic instability, or postoperative morbidity in patients undergoing adrenalectomy for pheochromocytoma.