title: Point of controversy: perioperative care of patients undergoing pheochromocytoma removal-time for a reappraisal?
abstract: Adrenalectomy for pheochromocytoma is reported with a mortality close to zero in recent studies. The dogma of preoperative fluid and hypotensive drug administrations is widely applied in patients scheduled for pheochromocytoma removal and is assumed to have a beneficial effect on operative outcomes. This paradigm is only based on historical studies of non-standardized practices and criteria for efficacy, with no control group. Pre- and intraoperative hypovolemia have never been demonstrated in patients scheduled for pheochromocytoma removal. Recent improvements in outcome of patients undergoing adrenalectomy for pheochromocytoma could also be the result of improvement in surgical techniques and refinement in anesthetic practices. Whether better knowledge of the disease, efficiency of available intravenous short-acting vasoactive drugs, and careful intraoperative handling of the tumor make it possible to omit preoperative preparation in most patients scheduled for pheochromocytoma removal is presently questionable. We reviewed available literature in this respect.
authors.affiliation: Departments of Anesthesia and Critical Care Digestive and Endocrine Surgery, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris, Hôpital Cochin, EA 3623, Université Paris-Descartes, 27 rue du Faubourg Saint Jacques, 75679 Paris Cedex 14, France. claude.lentschener@cch.aphp.fr
authors.forename: Claude
authors.initials: C
authors.lastname: Lentschener
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gaujoux
authors.forename: Antoine
authors.initials: A
authors.lastname: Tesniere
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dousset
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D006973:Hypertension / Q000517:prevention & control; D007430:Intraoperative Care; D019990:Perioperative Care; D010673:Pheochromocytoma / Q000601:surgery*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000601:surgery