| Evaluación de la utilidad de las variaciones del monitoreo del volumen latido no invasivo para ajustar el aporte de líquidos durante adrenalectomía laparoscópica en pacientes con feocromocitoma |
Examination of the usefulness of non-invasive stroke volume variation monitoring for adjusting fluid supplementation during laparoscopic adrenalectomy in patients with pheochromocytoma.
Isosu T, Obara S, Ohashi S, Hosono A, Nakano Y, Imaizumi T, Mogami M, Iida H, Murakawa M.
Department of Anesthesiology, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima, Japan. t-isosu@fmu.ac.jp
Fukushima J Med Sci. 2012;58(1):78-81
Abstract
PURPOSE OF THE STUDY: The measurement of stroke volume variation (SVV) using the FloTrac™ system (Edwards Lifescience, USA) is useful to estimate cardiac preload. We evaluated the benefits of SVV monitoring for adjusting fluid supplementation during laparoscopic adrenalectomy under anesthesia in patients with pheochromocytoma. SUBJECTS AND METHODS: Among 10 patients who underwent laparoscopic adrenalectomy for pheochromocytoma in our institution from June 2004 to December 2009, SVV was not monitored in 5 patients (group I) and in the other 5 patients (group II), SVV monitoring was performed. Subject age, height and body weight, total volume of fluid supplemented, blood loss, urine output and net fluid in-out balance during the procedure were retrospectively assessed. In those with SVV monitoring, infusion volume was adjusted for SVV less than 13%.RESULTS: There were significant differences in the patient age and body weight between the two groups (group I: 64.2 years old and 55.1 kg; group II: 43.6 years old and 71.7 kg). Both total infusion volume and urine output were significantly higher in group I compared with group II (5,610 vs. 2,400 ml and 1,125 vs. 750 ml, respectively). Total blood loss was similar between the two groups. Values of the net fluid balance divided by the body weight and total anesthesia period (hr) were significantly lower in group II compared with group I (I; +13.2 in group I and +6.2 in group II, ml/kg/hr). CONCLUSIONS: These data suggest that SVV monitoring is helpful to estimate the optimal volume for fluid supplementation and could prevent excessive fluid infusion during surgical procedures.
https://www.jstage.jst.go.jp/article/fms/58/1/58_78/_pdf
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| Manejo intraoperatorio de pacientes con tumores incidentales productores de catecolaminas: revisión y análisis de la literatura |
Intraoperative management of patients with incidental catecholamine producing tumors: A literature review and analysis.
Hariskov S, Schumann R.
Department of Anesthesiology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
J Anaesthesiol Clin Pharmacol. 2013 Jan;29(1):41-6. doi: 10.4103/0970-9185.105793.
Abstract
CONTEXT: Present knowledge about intraoperative management, morbidity, and mortality of patients with undiagnosed catecholamine-producing tumors is mostly based on published case reports and anecdotal evidence. AIMS: The aim was to summarize the management and outcomes of reported cases and analyze for practice patterns, deduct useful management recommendations as applicable. SETTINGS AND DESIGN: The Medline database was searched with specific keywords for the period of 1988-2010 for cases of incidental pheochromocytomas and paragangliomas. MATERIALS AND METHODS: Case reports in the English language with a postoperative diagnosis of pheochromocytoma and paraganglioma by histopathology were included. Systematic data extraction from case reports was done. STATISTICAL ANALYSIS USED: Descriptive statistics were applied.RESULTS: Of 823 retrieved records, 62 case reports met inclusion criteria. Hemodynamic instability occurred primarily during mass manipulation/intraoperatively (52%, n = 32) and induction/laryngoscopy (18%, n = 11). In cases reporting specific antihypertensive treatments, nitrates (67%, n = 30) represented the majority of medications used, followed by beta-blockers (47%, n = 21). Alpha receptor blockers were administered in 33% (n = 15). The perioperative mortality was 8% (n = 5), and none of these patients received intraoperative alpha blockade. A catecholamine-secreting tumor was suspected intraoperatively in 26% of cases. CONCLUSIONS: The perioperative mortality based on the reviewed cases of incidental catecholamine producing tumors was less than would traditionally be expected. Intraoperative alpha receptor blockade to treat hypertension was reported in 33% of cases, and none of the patients with a fatal outcome had received it. A higher intraoperative index of suspicion and a lower threshold to consider alpha blocking medications for severe intraoperative hypertension may improve outcomes.
KEYWORDS: Adrenal gland neoplasms, adrenal incidentaloma, anesthesia - general, outcome assessment, paraganglioma
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| Manejo del feocromocitoma: ideas antiguas y nuevas drogas |
Management of pheochromocytoma: old ideas and new drugs.
Domi R, Laho H.
Department of Anesthesia and Intensive Care, University Hospital Center, Mother Teresa, Albania. rudilaureta@hotmail.com
Niger J Clin Pract. 2012 Jul-Sep;15(3):253-7. doi: 10.4103/1119-3077.100616.
Abstract
Pheochromocytoma presents a challenge to the surgery team because of its clinical features and implications. The patient must be treated before the surgery until a stable hemodynamically state is achieved. The preoperative treatment includes α2-short acting adrenergic blocking and β-blocker agents. The most crucial intraoperative moments are induction of anesthesia and hemodynamic oscillations. An adequate preoperative preparation, modern anesthetic drugs, good collaboration between the surgeons and the anesthesiologists, and postoperative care decrease the rate of complications and improve the outcome. This review aims to discuss all the possible pharmacological strategies of perioperative management of phoechromocytoma, focusing on new drugs and treatments.
http://www.njcponline.com/article.asp?issn=1119-3077;year=2012;volume=15;issue=3;spage=253;epage=257;aulast=Domi
Atentamente
Dr. Juan C. Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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