[Anesthetic management for pheochromocytoma resection: a comparison of epinephrine predominant and norepinephrine predominant pheochromocytoma].
Eleven patients with pheochromocytoma were divided into two groups; epinephrine predominant group (n = 4) and norepinephrine predominant group (n = 7). In each case, anesthesia was given using only inhalational anesthetics and adenosine triphosphate (ATP); and the same strategy was used to control cardiovascular variables. If arterial blood pressure, pulmonary artery pressure, central venous pressure or heart rate failed to be controlled with the strategy before the tumor resection, phentolamine, trinitroglycerine or propranolol was used. After the tumor resection, if decreasing the anesthetic concentration, cessation of ATP infusion and rapid intravenous infusion could not maintain the systolic arterial blood pressure above 80 mmHg, norepinephrine was infused. Maximum heart rate and arterial blood pressure during the tumor exploration were similar in both groups. No ventricular arrhythmias were recognized in any case. The frequency of usage of the cardiovascular depressants was not different between the two groups. In the norepinephrine predominant group, five cases required norepinephrine infusion after the tumor resection, but in the epinephrine predominant group, none required the norepinephrine infusion. Desensitization of alpha 1 adrenergic receptor induced by continuous high plasma norepinephrine concentration, was considered to decrease vascular resistance. In conclusion, except for the hypotension after the tumor resection in the norepinephrine predominant pheochromocytoma, both epinephrine predominant and norepinephrine predominant pheochromocytoma could be managed with similar anesthetic risks.
Doi
M
M
Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine.
Ikeda
K
K
D000310:Adrenal Gland Neoplasms / Q000378:metabolism / Q000601:surgery*; D000328:Adult; D000758:Anesthesia / Q000379:methods*; D004837:Epinephrine / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage / Q000378:metabolism*; D010673:Pheochromocytoma / Q000378:metabolism / Q000601:surgery*
D009638:Norepinephrine; D004837:Epinephrine