[Use of urapidil during surgery for pheochromocytoma].
OBJECTIVE
To investigate the efficacy of urapidil, administered either by boluses or a continuous infusion, to control hypertension during resection of phaeochromocytoma.


METHODS
Prospective open study.


METHODS
Seven consecutive patients aged between 23 and 60 years, with a hypersecretant phaeochromocytoma.


METHODS
Standard anaesthetic technique including thiopentone, opioid, muscle relaxant, nitrous oxide and isoflurane. Invasive haemodynamic monitoring with a Swan-Ganz catheter and radial arterial catheterization. Infusion of cristalloids and colloids (20 mL.kg-1.h-1). Evaluation of two regimens of urapidil administration following the initial injection of a bolus of 25 mg in case of severe hypertension i.e. SAP > 180 mmHg > 1 min: a) boluses of 25 or 50 mg of urapidil injected according to the response obtained after the first bolus or in case of resurgence of a new hypertensive event; b) continuous infusion of 150-200 mg.h-1.


RESULTS
Three patients developed hypertension between the induction of anaesthesia and the beginning of the tumor dissection. One bolus of 25 or 50 mg of urapidil was efficient to control this event. During the dissection of the phaechromocytoma, higher doses (75-100 mg) were required to significantly decrease SAP and DAP values (P < 0.001). Heart rate did not change significantly in patients not receiving esmolol. A continuous infusion, used in three patients, did not prevent the occurrence of peaks in two patients, requiring additional doses. After the removal of the tumor, three patients experienced severe hypotension with decreased systemic vascular resistances and high cardiac output. Vasoactive drugs were injected to restore better haemodynamic conditions.


CONCLUSIONS
Urapidil is useful for the management of hypertension during the resection of phaechromocytoma. However further investigations are needed to determine its role in the occurrence of prolonged collapse after the tumor removal.
Steib
A
A
Service d'anesthésie et de réanimation, hôpital de Hautpierre, Strasbourg, France.
Collin
F
F
Stojeba
N
N
Coron
T
T
Weber
J C
JC
Beller
J P
JP
D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000328:Adult; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007430:Intraoperative Care; D008875:Middle Aged; D010673:Pheochromocytoma / Q000601:surgery*; D010879:Piperazines / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies
D000959:Antihypertensive Agents; D010879:Piperazines; C015568:urapidil
Utilisation de l'urapidil au cours de la chirurgie du phéochromocytome.