These drugs probably reduce the complications of hypertensive crisis, the wide bp fluctuations during manipulation of the tumor especially until venous drainage is obliterated, and the myocardial dysfunction that occurs perioperatively. By some estimates, 25 to 50 percent of hospital deaths of patients with unmanaged or unknown pheochromocytoma occur during induction of anesthesia or during operative procedures for other conditions. Pheochromocytoma is pharmacologically volatile, potentially lethal catecholamine containing tumor of chromaffin tissues1. Although several cases have been reported, the literature contains few descriptions of perioperative. Pcb 4833 5834 advanced human physiology graduate student case study presentation university of central florida spring 2016 sorry for the poor editing i study biomedical science, not digital. The facts you need to know pheochromocytoma is a part of the pheochromocytoma and paraganglioma group of syndromes. Perioperative care of phaeochromocytoma bja education oxford. In summary, we present echocardiographic findings in a case of cardiomyopathy in a patient with pheochromocytoma. Update in perioperative anesthetic management of pheochromocytoma. Also, availability of laparoscopic and robotic adrenalsparing adrenalectomy has reduced hospital stay and hastened recovery. Use of an anaesthetic agent methoxyflurane or fluroxene which is not associated with release of.
Pheochromocytoma and its anaesthetic management slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. The observations of deterioration of preoperartive biventricular function that improved significantly postadenalectomy support the diagnosis of catecholamineinduced cardiomyopathy. Pdf pheochromocytoma represents very significant challenges to the anesthetist, especially when undiagnosed. Halothane anesthesia and catecholamine levels in a patient. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that. Central venous access is necessary, if only for drug infusions, and can usually be inserted after induction. Adrenergic blockade is the most helpful in treating hypertension preoperatively.
Perioperative management of pheochromocytoma sciencedirect. International research journal of pharmacy and medical sciences issn online. The surgery was uneventfully accomplished with general anesthesia combined with epidural anesthesia. We present three cases of lifethreatening crisis in which magnesium sulfate was particularly beneficial in controlling symptoms and signs when more conventional forms of therapy had failed. Pheochromocytoma presented by susie clabots, linnea cooper, and stephen coots slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. The latter was performed with the aim of not only perioperative pain management but also of promoting intestinal peristalsis. These chromaffin tissue tumors are not uncommon in anesthetic practice and have varied manifestations. It describes advanced imaging and biochemical techniques for diagnosis and localisation. On the preoperative visit, supine and standing blood pressure were measured which revealed no postural hypotension. This may induce high blood pressure, a rapid heartbeat, flushed skin, sweating, headache and tremors. With about half of paraganglioma tumors, the abnormal cells produce hormones known as catecholamines or adrenaline, which is the fightorflight hormone. Gastrointestinal pseudoobstruction, or paralytic ileus, can be caused by pheochromocytoma with hypersecretion of catecholamines, which act on. The perioperative course and anesthetic management.
Paragangliomas are also catecholaminesecreting tumors arising from extraadrenal chromaffin cells located along the sympathetic paravertebral ganglia of the pelvis, abdomen, and thorax. Pheochromocytomas are catecholaminesecreting tumors that arise from the chromaffin cells located within the adrenal medulla. A paraganglioma grows in the sympathetic or parasympathetic nerves. Pheochromocytoma hypertension treatment open anesthesia.
The serious and potentially lethal nature of such complications is due to the potent effect of. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Several reports have described the use of methoxyflurane for the removal of pheochromocytoma, 8,9 but, to our knowledge, there is only one published instance of fluroxene anesthesia for pheochromocytoma removal. Contemporary perioperative and anesthetic management of. Pheochromocytoma hypertension treatment definition preoperative hypertension treatment. Fluroxene anesthesia for pheochromocytoma removal jama. Winner of the standing ovation award for best powerpoint templates from presentations magazine. In approximately 60 percent of patients, the tumor is discovered incidentally during computed tomography ct or magnetic resonance imaging mri of the abdomen for unrelated symptoms 3. Preoperative preparation with adrenergic blocking agents, following the criteria of harrisonet al. Transcranial magnetic stimulation tms is a noninvasive method that can be used as an interventional technique to investigate causality in the brainbehavior relationship, through depolarization. You can manage this and all other alerts in my account. With advancement in surgical and anesthetic techniques, the incidence of. Preoperative management of the pheochromocytoma patient. Pediatric anesthetic management of the surgical resection.
Implications and considerations during pheochromocytoma. Pheochromocytomas are rare neuroendocrine tumors that produce and store catecholamines. Daniel p goldstein 1, marcia r voigt 1 and daniel ruan 2 1 department of surgery, wake forest school of medicine, 475 vine street, bowman gray center for medical education, winstonsalem, nc 27101, usa 2 department of surgery, tampa general hospital, 1 tampa. Pheochromocytoma crisis is a rare lifethreatening event that may appear with a variety of clinical symptoms. Anaesthesia recommendations for patients suffering from. Vasopressin for hemodynamic rescue in catecholamine. Surgery to remove the tumor is usually the first treatment choice for a paraganglioma, if. Pediatric anesthetic management of the surgical resection of recurrent pheochromocytoma in a patient with resolution of severe dilated cardiomyopathy jenna helmer sobey, md thanh nguyen, md humphrey lam, md thomas austin, md. Of pheochromocytoma a case report a turkistani introduction pheochromocytoma is pharmacologically volatile, potentially lethal catecholaminecontaining tumor of chromaffin tissues1. Catecholamineinduced cardiomyopathy and pheochromocytoma.
Pdf anesthesia considerations for pheochromocytoma. Desflurane, which is favored in ambulatory anesthesia for its low bloodgas partition coefficient and resultant rapid emergence does cause significant sympathetic stimulation and is considered by many to be avoided. Without adequate preparation, the release of excessive amounts of catecholamines, especially during anesthetic induction or during surgical removal, can produce lifethreatening cardiovascular complications. This neuroendocrine tumor is associated with a most unpredictable and fluctuating clinical course during anesthesia and surgical. Pheochromocytoma is a rare disorder that presents challenges for the anesthesiologist. Sudden hypertension during surgical anesthesia should be treated with the urgency associated with cardiac arrest. In one case it responded promptly to administration of phentolamine. Patients who undergo pheochromocytoma resection exhibit labile blood pressure bp, arrhythmias, and tachy cardia during and after surgery. Once considered nightmare by anaesthesiologist, pheochromocytoma have. The best approach for pheochromocytoma treatment is surgical excision of the affected adrenal gland. If you continue browsing the site, you agree to the use of cookies on this website. Revisiting anesthetic management of pheochromocytoma ecronicon. Anesthetic management of gigantic pheochromocytoma resection. Anesthesia for the adult with pheochromocytoma uptodate.
This report describes one case of anesthetic management about surgical resection of a malignant phaeochromocytoma with tumor extension. Anesthesia may be induced with intravenous injection of propofol, etomidate, or barbiturates in combi nation with synthetic opioids. The introduction of alpha adrenergic blockade medication, such as phentolamine and phenoxybenzamine had the highest impact in perioperative mortality reduction due to inhibition of the deleterious effect. No inhospital blood pressure reading higher than 16590 mmhg should be evident for 48 hours. Phenoxybenzamine is the preferred drug for preoperative preparation to control blood pressure and arrhythmia. Sevoflurane is widely used for pheochromocytoma excision. Pheochromocytoma represents very significant challenges to the anesthetist, especially when undiagnosed. The safe anaesthetic management of a child with a phaeochromocytoma requires an understanding of the pathophysiology of the disease, together with a thorough knowledge of its pharmacology, in order to avoid or minimize the potentially harmful cardiovascular changes that may occur during anaesthesia. Halothane anesthesia and catecholamine levels in a patient with pheochromocytoma you will receive an email whenever this article is corrected, updated, or cited in the literature. The anaesthetic management of a patient with pheochromocytoma is discussed. Patient was referred to anesthesia department for assessment. Current perioperative management of pheochromocytomas.
Learn more about the symptoms, causes, treatments, and diagnosis including tests of pheochromocytoma. Ppt pheochromocytoma powerpoint presentation free to. Pheochromocytomas are catecholamine producing tumors and although uncommon present a great challenge to the anesthesiologist since it has nonspecific clinical symptoms and risk of critical events, including death when not previously diagnosed. Who classification of endocrine tumors defines pheochromocytoma pcc as a. Pheochromocytoma and its anaesthetic implications authorstream presentation. Symptoms include headache, sweating, palpitations, elevated blood pressure, anxiety, nausea, tremors and more. Assistant professor of anesthesia, senior anesthesia resident, department of anesthesia. The initial dosage is 10 mg once or twice daily, and the dose is increased by 10 to 20 mg in divided doses every 2 to 3 days as needed to control blood pressure and spells table 168. Anuja definition pheochromocytoma is a catecholamine secreting tumour arising from the chromaffin cells of the sympathetic nervous system in the adrenal medulla and the sympathetic chain that can cause severe hypertension and other systemic disturbances pheochromocytomas are often described according to the rule of 10s. Perioperative management of pheochromocytoma mayo clinic. Current concepts in anesthetic management harish ramakrishna department of anesthesiology, division of cardiovascular and thoracic anesthesiology, mayo clinic, arizona, 5777 east mayo boulevard, phoenix, az 85054, usa. Obstetrical and pediatric anesthesia pheochromocytoma and pregnancy.
Current preoperative preparation of pheochromocytoma. Since treatment of pheochromocytoma almost always includes. Perioperative anesthetic management of intestinal pseudo. A more recent series of 143 patients who underwent pheochromocytoma or paragan. General anesthesia or epidural anesthesia spinal anesthesia. Clinical manifestation is variable, unspecific and depends on the catecholamine production profile. Pheochromocytoma is a rare neuroendocrine tumor, occurring in less than 0. Review article current preoperative preparation of pheochromocytoma paraganglioma syndrome. The suspicion of pheochromocytoma was verified when autopsy revealed a tumor in the left adrenal gland which weighed 1. Invasive arterial monitoring should be obtained before induction of anaesthesia. Increased incidence of intrauterine fetal demise, growth restriction, abruption.
Patients with pheochromocytoma may develop complicated and potentially lethal cardiovascular and other complications, especially in the setting of diagnostic or interventional procedures e. No inhospital blood pressure reading higher than 16590 mmhg should be evident for 48 hours before surgery. Since treatment of pheochromocytoma almost always includes surgical resection, most of these patients will require anesthesia. Perioperative care of phaeochromocytoma bja education. They are clinically relevant in perioperative medicine because. Pheochromocytoma is one such pathological entity which has got multidimensional challenging aspects in spite of our improved understanding of its physiological and clinical behavior during surgical resection. There is no evidence base to support the use of cardiac output monitoring in phaeochromocytoma surgery. Perioperative management of pheochromocytoma remains an anesthetic challenge.
The best approach for pheochromocytoma treatment is the surgical excision of the affected adrenal gland. International research journal of pharmacy and medical sciences, volume 1, issue 1, pp. A pheochromocytoma is a tumor arising in the adrenal gland medulla. The perioperative management of these tumors has improved remarkably over the years, in.
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