It is a great challenge for the anesthesia team to maintain hemodynamic stability during general anesthesia for laparoscopic adrenalectomy in patients with pheochromocytoma. Preoperative alpha blockade is a pathophysiological approach for reduction of the effects of high catecholamine plasma levels. We conducted a retrospective, observational study on 19 adrenalectomies performed in the period 2009–2019 in our hospital. The aim was to analyze hemodynamic instability in the context of preoperative alpha blockade with Prazosin. The results showed that despite preoperative preparation, both extreme hypertension and episodes of hypotension were observed intraoperatively. Large, prospective, randomized, controlled studies are needed to establish the best blockade regimen to achieve better hemodynamic stability intraoperatively.
Bruynzeel H, Feelders RA, Groenland THN, et al. Risk Factors for Hemodynamic Instability during Surgery for Pheochromocytoma. J Clin Endocrinol Metab 2010 ; 95 : 678–685.
Butterworth J, Mackey D, Wasnick J. Morgan and Mikhail’s Clinical Anesthesiology, 6th edition. 2020.
Castinetti F, Freminville J-BD, Guerin C, et al. Controversies about the systematic preoperative pharmacological treatment before pheochromocytoma or paraganglioma surgery. Eur J Endocrinol 2022 ; 186 : D17–D24.
Chen H, Sippel RS, O’Dorisio MS, et al. The North American Neuroendocrine Tumor Society consensus guideline for the diagnosis and management of neuroendocrine tumors: pheochromocytoma, paraganglioma, and medullary thyroid cancer. Pancreas 2010 ; 39 : 775–783.
Conzo G, Tartaglia E, Gambardella C, et al. Minimally invasive approach for adrenal lesions: Systematic review of laparoscopic versus retroperitoneoscopic adrenalectomy and assessment of risk factors for complications. Int J Surg Lond Engl 2016 ; 28 Suppl 1 : S118-123.
Domi R, Sula H, Kaci M, et al. Anesthetic Considerations on Adrenal Gland Surgery. J Clin Med Res 2015 ; 7 : 1–7.
Goldstein RE, O’Neill JA, Holcomb GW, et al. Clinical experience over 48 years with pheochromocytoma. Ann Surg 1999 ; 229 : 755–764; discussion 764-766.
van der Horst-Schrivers ANA, Kerstens MN, Wolffenbuttel BHR. Preoperative pharmacological management of phaeochromocytoma. Neth J Med 2006 ; 64 : 290–295.
Kocak S, Aydintug S, Canakci N. Alpha blockade in preoperative preparation of patients with pheochromocytomas. Int Surg 2002 ; 87 : 191–194.
Lafont M, Fagour C, Haissaguerre M, et al. Per-operative hemodynamic instability in normotensive patients with incidentally discovered pheochromocytomas. J Clin Endocrinol Metab 2015 ; 100 : 417–421.
Lenders JWM, Duh Q-Y, Eisenhofer G, et al. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2014 ; 99 : 1915–1942.
Livingstone M, Duttchen K, Thompson J, et al. Hemodynamic Stability During Pheochromocytoma Resection: Lessons Learned Over the Last Two Decades. Ann Surg Oncol 2015 ; 22 : 4175–4180.
Miller E and LRD. Miller’s Anesthesia 8th edition. 8th ed. 2015.
Pacak K, Eisenhofer G, Ahlman H, et al. Pheochromocytoma: recommendations for clinical practice from the First International Symposium. October 2005. Nat Clin Pract Endocrinol Metab 2007 ; 3 : 92–102.
Plouin PF, Duclos JM, Soppelsa F, et al. Factors associated with perioperative morbidity and mortality in patients with pheochromocytoma: analysis of 165 operations at a single center. J Clin Endocrinol Metab 2001 ; 86 : 1480–1486.
Prys-Roberts C, Farndon JR. Efficacy and safety of doxazosin for perioperative management of patients with pheochromocytoma. World J Surg 2002 ; 26 : 1037–1042.
Ramakrishna H. Pheochromocytoma resection: Current concepts in anesthetic management. J Anaesthesiol Clin Pharmacol 2015 ; 31 : 317–323.
Roizen MF, Horrigan RW, Koike M, et al. A PROSPECTIVE RANDOMIZED TRIAL OF FOUR ANESTHETIC TECHNIQUES FOR RESECTION OF PHEOCHROMOCYTOMA. Anesthesiology 1982 ; 57 : A43.
Schreiner F, Anand G, Beuschlein F. Perioperative Management of Endocrine Active Adrenal Tumors. Exp Clin Endocrinol Diabetes Off J Ger Soc Endocrinol Ger Diabetes Assoc 2019 ; 127 : 137–146.
Song G, Joe BN, Yeh BM, et al. Risk of catecholamine crisis in patients undergoing resection of unsuspected pheochromocytoma. Int Braz J Urol Off J Braz Soc Urol 2011 ; 37 : 35-40;discussion 40-41.
Subramaniam R. Pheochromocytoma – Current concepts in diagnosis and management. Trends Anaesth Crit Care 2011 ; 1 : 104–110.
Sunil Kumar K, Siva Krishna K, Sandip P, et al. Pheochromocytoma: An Uncommon Presentation of an Asymptomatic and Biochemically Silent Adrenal Incidentaloma. Malays J Med Sci MJMS 2012 ; 19 : 86–91.
Tessier DJ, Iglesias R, Chapman WC, et al. Previously unreported high-grade complications of adrenalectomy. Surg Endosc 2009 ; 23 : 97–102.
Thompson JP, Bennett D, Hodson J, et al. Incidence, risk factors and clinical significance of postoperative haemodynamic instability after adrenalectomy for phaeochromocytoma. Gland Surg 2019 ; 8 : 729–739.
Weingarten TN, Cata JP, O’Hara JF, et al. Comparison of two preoperative medical management strategies for laparoscopic resection of pheochromocytoma. Urology 2010 ; 76 : 508.e6–11.
