Endocrine Abstracts

Aim: The introduction of modern pheochromocytoma anesthetic management in a specialized endocrinology center with using of the algorithm of SPOHM.

Materials and methods: The implementation of pheochromocytoma anesthetic management in 65 women during surgical intervention by video assistant laparoscopic adrenalectomy. All patients were used an algorithm of SPOHM: preoperative tableted hypotensive therapy before admission (outpatients); preoperative infusion controlled hypotensive therapy by urapidil and correction of hipovolemia by balanced crystalloid solutions and a colloid solution 4-6 mg/kg were applied on the 2nd stage; intraoperative infusion controlled antihypertensive therapy by urapidil on the 3rd stage under the control of non-invasive hemodynamic monitoring (NIHM) and prevention of adrenal insufficiency with final hypovolemia correction on the last 4th stage.

Results and Discussion: All patients had significantly (P = 0,0087) increased levels of daily urine metanephrines up to 3080.8 ± 295.7 mg/24 h (control of 169.3 ± 12.7 mg/24 h). According to SPOHM doxazosin 9.72 ± 0.96 mg twice-daily or urapidil 144.0 ± 11.2 mg twice-daily were used at the first stage. On the second stage performed haemodilution by 6-10% solution of HES or 4% Gelatine and controlled infusion antihypertensive therapy by urapidil in anaverage speed 9.7 ± 1.9 mg/hr. During the third stage infusion rate of Urapidil was 1.25 ± 0.08 mg/min (additionaly, in time of the pheochromocytoma surgical separation, urapidil bolus was administered in dosages 25–50 mg IV when the slightest increasing of blood pressure was detected by NIHM, especially cardiac output changes). On the fourth stage was conducted the prevention of adrenal insufficiency by hydrocortyzon replacementtherapy and hypovolemia. No mortality cases were observed.

Conclusions: The introduction of SPOHM has ensured high efficiency and safety of laparoscopic adrenalectomy under general anesthesia and an absence of lethal cases.