M Araujo-Castro1, E Pascual-Corrales2, L Nattero Chavez2, A Martínez Lorca3, T Alonso-Gordoa4, J Molina-Cerrillo4, J Lorca Álvaro5, C Mínguez Ojeda5, S Redondo López6, R Barberá Durbán7, R Polo López7, N Moreno Mata8, U Caballero Silva8, H Pian9, I Ruz-Caracuel9, A Sanjuanbenito Dehesa10, V Gómez Dos Santos5, A B Serrano Romero11. 1. Neuroendocrinology Division, Department of Endocrinology and Nutrition, IRYCIS, Hospital Universitario Ramón y Cajal, Colmenar Viejo street, S/N, 28034, Madrid, Spain. marta.araujo@salud.madrid.org. 2. Neuroendocrinology Division, Department of Endocrinology and Nutrition, IRYCIS, Hospital Universitario Ramón y Cajal, Colmenar Viejo street, S/N, 28034, Madrid, Spain. 3. Department of Nuclear Medicine, Hospital Universitario Ramón y Cajal, Madrid, Spain. 4. Department of Medical Oncology, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain. 5. Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain. 6. Department of Vascular Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain. 7. Department of Otorhinolaryngology, Hospital Universitario Ramón y Cajal, Madrid, Spain. 8. Department of Thoracic Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain. 9. Department of Pathology, Hospital Universitario Ramón y Cajal, Madrid, Spain. 10. Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain. 11. Department of Anesthesia, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Abstract
OBJECTIVE: To offer a practical guide for the presurgical and anesthetic management of pheochromocytomas and sympathetic paragangliomas (PGLs). METHODS: This protocol was based on a comprehensive review of the literature and on our own multidisciplinary team's experience from managing pheochromocytoma and sympathetic PGLs at a referral center. RESULTS: Patients with pheochromocytomas and sympathetic paragangliomas (PGLs) may develop potentially life-threatening complications, especially during surgical procedures. A complete biochemical, radiological, genetic, and cardiological assessment is recommended in the preoperative stage as it provides an evaluation of the risk of surgical complications and malignancy, allowing individualization of the presurgical treatment. Treatment with α-blockade and proper volume expansion in the preoperative stage significantly reduces the perioperative morbidity. During surgery, the anesthesiologist should look for a deep anesthetic level that inhibits the cardiovascular effects of catecholamines to minimize the risk of intraoperative complications. CONCLUSIONS: An optimal presurgical evaluation of pheochromocytomas/ sympathetic PGL requires a multidisciplinary approach, including a complete hormonal, radiological, cardiac, genetic, and functioning evaluation in most cases. A proper preoperative evaluation in combination with strict blood pressure and heart rate control, and blood volume status optimization, will significantly reduce the risk of intraoperative and perioperative complications. In those patients who unfortunately develop intraoperative complications, the role of the anesthesiologist is essential since the selection of the appropriate management has a direct impact on morbimortality reduction.
OBJECTIVE: To offer a practical guide for the presurgical and anesthetic management of pheochromocytomas and sympathetic paragangliomas (PGLs). METHODS: This protocol was based on a comprehensive review of the literature and on our own multidisciplinary team's experience from managing pheochromocytoma and sympathetic PGLs at a referral center. RESULTS: Patients with pheochromocytomas and sympathetic paragangliomas (PGLs) may develop potentially life-threatening complications, especially during surgical procedures. A complete biochemical, radiological, genetic, and cardiological assessment is recommended in the preoperative stage as it provides an evaluation of the risk of surgical complications and malignancy, allowing individualization of the presurgical treatment. Treatment with α-blockade and proper volume expansion in the preoperative stage significantly reduces the perioperative morbidity. During surgery, the anesthesiologist should look for a deep anesthetic level that inhibits the cardiovascular effects of catecholamines to minimize the risk of intraoperative complications. CONCLUSIONS: An optimal presurgical evaluation of pheochromocytomas/ sympathetic PGL requires a multidisciplinary approach, including a complete hormonal, radiological, cardiac, genetic, and functioning evaluation in most cases. A proper preoperative evaluation in combination with strict blood pressure and heart rate control, and blood volume status optimization, will significantly reduce the risk of intraoperative and perioperative complications. In those patients who unfortunately develop intraoperative complications, the role of the anesthesiologist is essential since the selection of the appropriate management has a direct impact on morbimortality reduction.
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