Laurent Brunaud1, Myriam Boutami2, Phi-Linh Nguyen-Thi3, Brendan Finnerty4, Adeline Germain5, Georges Weryha6, Thomas J Fahey4, Eric Mirallie2, Laurent Bresler7, Rasa Zarnegar4. 1. Department of Digestive, Hepato-Biliary and Endocrine Surgery, CHU Nancy - Hospital Brabois Adultes, University de Lorraine, Nancy, France; Faculty de medicine, INSERM U954, University de Lorraine, Nancy, France. Electronic address: l.brunaud@chu-nancy.fr. 2. Department of Digestive and Endocrine Surgery, CCDE, IMAD, CHU Nantes, Université de Nantes, Nantes, France. 3. Department of Clinical Epidemiology and Evaluation, CHU Nancy, University de Lorraine, Nancy, France. 4. Division of Endocrine and Minimally Invasive Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY. 5. Department of Digestive, Hepato-Biliary and Endocrine Surgery, CHU Nancy - Hospital Brabois Adultes, University de Lorraine, Nancy, France; Faculty de medicine, INSERM U954, University de Lorraine, Nancy, France. 6. Department of Endocrinology, University de Lorraine, CHU Nancy - Hospital Brabois Adultes, Nancy, France. 7. Department of Digestive, Hepato-Biliary and Endocrine Surgery, CHU Nancy - Hospital Brabois Adultes, University de Lorraine, Nancy, France.
Abstract
BACKGROUND: Alpha-blockade is the standard management preoperatively to prevent intraoperative hemodynamic instability (IHD) during resection of a pheochromocytoma. Calcium channel blockers also have been shown to lessen the risk of IHD. We aim to determine differences between these classes of antihypertensive agents in minimizing IHD. METHODS: This was a retrospective analysis from a tri-institutional database. Inclusion criteria were unilateral transabdominal adrenalectomy for pheochromocytomas between 2002 and 2012. IHD was defined as at least one systolic blood pressure (SBP) measurement >160 mm Hg and at least one episode of mean arterial pressure 60 mm Hg. RESULTS: A total of 155 patients were included: 110 receiving calcium channel blockers, 41 alpha-blockade, and 4 no medication. Intraoperatively, mean maximal SBP was less after alpha-blockade (P < .0001) as well as the incidence and duration of episodes of SBP >200 mm Hg (P < .01); however, severe hypotensive episodes (MAP <60 mm Hg) were more frequent (P < .001) and longer (P < .0001) with alpha-blockade. Consequently, intraoperative vasoactive drugs were used more frequently (P = .03), and mean fluid volume infused was larger (P < .001). Fifty-four patients had IHD, but these were independent of type of preoperative medication used. Familial disease was the only independent predictor of IHD. CONCLUSION: IHD was independent of type of preoperative medical management but was dependent on familial disease. These findings broaden options for clinicians in the preoperative management of pheochromocytoma.
BACKGROUND: Alpha-blockade is the standard management preoperatively to prevent intraoperative hemodynamic instability (IHD) during resection of a pheochromocytoma. Calcium channel blockers also have been shown to lessen the risk of IHD. We aim to determine differences between these classes of antihypertensive agents in minimizing IHD. METHODS: This was a retrospective analysis from a tri-institutional database. Inclusion criteria were unilateral transabdominal adrenalectomy for pheochromocytomas between 2002 and 2012. IHD was defined as at least one systolic blood pressure (SBP) measurement >160 mm Hg and at least one episode of mean arterial pressure 60 mm Hg. RESULTS: A total of 155 patients were included: 110 receiving calcium channel blockers, 41 alpha-blockade, and 4 no medication. Intraoperatively, mean maximal SBP was less after alpha-blockade (P < .0001) as well as the incidence and duration of episodes of SBP >200 mm Hg (P < .01); however, severe hypotensive episodes (MAP <60 mm Hg) were more frequent (P < .001) and longer (P < .0001) with alpha-blockade. Consequently, intraoperative vasoactive drugs were used more frequently (P = .03), and mean fluid volume infused was larger (P < .001). Fifty-four patients had IHD, but these were independent of type of preoperative medication used. Familial disease was the only independent predictor of IHD. CONCLUSION: IHD was independent of type of preoperative medical management but was dependent on familial disease. These findings broaden options for clinicians in the preoperative management of pheochromocytoma.
Authors: Laurent Brunaud; Phi-Linh Nguyen-Thi; Eric Mirallie; Marco Raffaelli; Menno Vriens; Pierre-Etienne Theveniaud; Myriam Boutami; Brendan M Finnerty; Wessel M C M Vorselaars; Inne Borel Rinkes; Rocco Bellantone; Celestino Lombardi; Thomas Fahey; Rasa Zarnegar; Laurent Bresler Journal: Surg Endosc Date: 2015-06-20 Impact factor: 4.584
Authors: Henrique Vara Luiz; Mary Jane Tanchee; Maria G Pavlatou; Run Yu; Joan Nambuba; Katherine Wolf; Tamara Prodanov; Robert Wesley; Karen Adams; Tito Fojo; Karel Pacak Journal: Clin Endocrinol (Oxf) Date: 2016-04-15 Impact factor: 3.478
Authors: H Groeben; M K Walz; B J Nottebaum; P F Alesina; A Greenwald; R Schumann; M W Hollmann; L Schwarte; M Behrends; T Rössel; C Groeben; M Schäfer; A Lowery; N Hirata; M Yamakage; J A Miller; T J Cherry; A Nelson; C C Solorzano; B Gigliotti; T S Wang; J K G Wietasch; P Friederich; B Sheppard; P H Graham; T N Weingarten; J Sprung Journal: Br J Surg Date: 2020-01 Impact factor: 6.939