title: Increased arterial pressure is not predictive of haemodynamic instability in patients undergoing adrenalectomy for phaeochromocytoma.
abstract: BACKGROUND
  Pre-operative hypotensive drugs are assumed to have dramatically decreased operative mortality and morbidity in patients undergoing phaeochromocytoma removal only in non-controlled studies. We evaluated the predictive value of pre-operative high systolic arterial pressure (SAP) on intra- and post-operative haemodynamic instability, in 96 patients undergoing laparoscopic adrenalectomy for phaeochromocytoma.
  
  
  METHODS
  Ninety-six consecutive patients underwent laparoscopic adrenalectomy for phaeochromocytoma. Pre-operative SAP was not systematically normalised, provided that increased SAP was clinically tolerated. Intravenous nicardipine, esmolol and norepinephrine were intraoperatively titrated to treat SAP increase >150 mmHg, tachycardia >90-110/min, arrhythmia or SAP decrease under 90 mmHg, respectively. Volume expanders were not systematically administered. Patients with increased and normal pre-operative SAP were compared with respect to (a) nicardipine, esmolol and norepinephrine requirement, (b) highest intraoperative SAP and heat rate, (c) lowest intraoperative SAP, (d) duration of surgery and (e) norepinephrine requirement following tumour removal.
  
  
  RESULTS
  Groups did not differ significantly with respect to data defined as being indicative of perioperative haemodynamic instability (all P values>0.05).
  
  
  CONCLUSIONS
  As previously demonstrated, in patients undergoing phaeochromocytoma removal, perioperative haemodynamic changes are mainly due to catecholamine release during tumour manipulation, and to the decrease in catecholamine level following tumour removal. Whether pre-operative hypotensive drugs are likely to alter these changes remains questionable.
  
  
  CONCLUSIONS
  For most patients scheduled for laparoscopic phaeochromocytoma removal, surgery can be carried out without systematic pre-operative arterial pressure normalisation.
authors.affiliation: Department of Anaesthesia and Critical Care, Université Paris-Descartes, Faculté de Médecine, Paris, France. claude.lentschener@cch.aphp.fr
authors.forename: C
authors.initials: C
authors.lastname: Lentschener
authors.forename: S
authors.initials: S
authors.lastname: Gaujoux
authors.forename: J M
authors.initials: JM
authors.lastname: Thillois
authors.forename: D
authors.initials: D
authors.lastname: Duboc
authors.forename: J
authors.initials: J
authors.lastname: Bertherat
authors.forename: Y
authors.initials: Y
authors.lastname: Ozier
authors.forename: B
authors.initials: B
authors.lastname: Dousset
mesh_terms: D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002395:Catecholamines / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000503:physiopathology / Q000601:surgery*; D013599:Systole
chemical_list: D002395:Catecholamines