A paraganglioma grows in the sympathetic or parasympathetic nerves. Also, availability of laparoscopic and robotic adrenalsparing adrenalectomy has reduced hospital stay and hastened recovery. The facts you need to know pheochromocytoma is a part of the pheochromocytoma and paraganglioma group of syndromes. No inhospital blood pressure reading higher than 16590 mmhg should be evident for 48 hours. Patients with pheochromocytoma may develop complicated and potentially lethal cardiovascular and other complications, especially in the setting of diagnostic or interventional procedures e. Pheochromocytomas are rare neuroendocrine tumors that produce and store catecholamines. 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.
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. Pheochromocytoma is a rare disorder that presents challenges for the anesthesiologist. Fluroxene anesthesia for pheochromocytoma removal jama. Although several cases have been reported, the literature contains few descriptions of perioperative. Pheochromocytoma is a rare neuroendocrine tumor, occurring in less than 0. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Of pheochromocytoma a case report a turkistani introduction pheochromocytoma is pharmacologically volatile, potentially lethal catecholaminecontaining tumor of chromaffin tissues1. Perioperative management of pheochromocytoma mayo clinic. Since treatment of pheochromocytoma almost always includes. With about half of paraganglioma tumors, the abnormal cells produce hormones known as catecholamines or adrenaline, which is the fightorflight hormone. 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. Who classification of endocrine tumors defines pheochromocytoma pcc as a. Contemporary perioperative and anesthetic management of. Phenoxybenzamine is the preferred drug for preoperative preparation to control blood pressure and arrhythmia.
Pdf pheochromocytoma represents very significant challenges to the anesthetist, especially when undiagnosed. 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. Sudden hypertension during surgical anesthesia should be treated with the urgency associated with cardiac arrest. Perioperative care of phaeochromocytoma bja education. 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. International research journal of pharmacy and medical sciences issn online. Preoperative preparation with adrenergic blocking agents, following the criteria of harrisonet al. International research journal of pharmacy and medical sciences, volume 1, issue 1, pp. No inhospital blood pressure reading higher than 16590 mmhg should be evident for 48 hours before surgery. Use of an anaesthetic agent methoxyflurane or fluroxene which is not associated with release of. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that. With advancement in surgical and anesthetic techniques, the incidence of.
The perioperative management of these tumors has improved remarkably over the years, in. Anaesthesia recommendations for patients suffering from. Sevoflurane is widely used for pheochromocytoma excision. Patients who undergo pheochromocytoma resection exhibit labile blood pressure bp, arrhythmias, and tachy cardia during and after surgery. 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. Pdf anesthesia considerations for pheochromocytoma. On the preoperative visit, supine and standing blood pressure were measured which revealed no postural hypotension. 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. The following points should be considered when treating such patients. Once considered nightmare by anaesthesiologist, pheochromocytoma have. Catecholamineinduced cardiomyopathy and pheochromocytoma. 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 crisis is a rare lifethreatening event that may appear with a variety of clinical symptoms. Complications of pheochromocytoma are because of unopposed action of high blood pressure on critical organs 30 bhavna gupta, lalit gupta, and kamna kakkar.
Obstetrical and pediatric anesthesia pheochromocytoma and pregnancy. The anaesthetic management of a patient with pheochromocytoma is discussed. Assistant professor of anesthesia, senior anesthesia resident, department of anesthesia. A more recent series of 143 patients who underwent pheochromocytoma or paragan. Ppt pheochromocytoma powerpoint presentation free to. Implications and considerations during pheochromocytoma. General anesthesia or epidural anesthesia spinal anesthesia.
The best approach for pheochromocytoma treatment is the surgical excision of the affected adrenal gland. This may induce high blood pressure, a rapid heartbeat, flushed skin, sweating, headache and tremors. 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. Since treatment of pheochromocytoma almost always includes surgical resection, most of these patients will require anesthesia. The serious and potentially lethal nature of such complications is due to the potent effect of. Update in perioperative anesthetic management of pheochromocytoma. 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. Increased incidence of intrauterine fetal demise, growth restriction, abruption.
Revisiting anesthetic management of pheochromocytoma ecronicon. Review article current preoperative preparation of pheochromocytoma paraganglioma syndrome. Perioperative care of phaeochromocytoma bja education oxford. A pheochromocytoma is a tumor arising in the adrenal gland medulla. Anesthesia may be induced with intravenous injection of propofol, etomidate, or barbiturates in combi nation with synthetic opioids.
This neuroendocrine tumor is associated with a most unpredictable and fluctuating clinical course during anesthesia and surgical. 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. Adrenergic blockade is the most helpful in treating hypertension preoperatively. 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. 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. Perioperative management of pheochromocytoma sciencedirect. The perioperative course and anesthetic management.
There is no evidence base to support the use of cardiac output monitoring in phaeochromocytoma surgery. The best approach for pheochromocytoma treatment is surgical excision of the affected adrenal gland. Winner of the standing ovation award for best powerpoint templates from presentations magazine. Current preoperative preparation of pheochromocytoma. The suspicion of pheochromocytoma was verified when autopsy revealed a tumor in the left adrenal gland which weighed 1. Pheochromocytoma and its anaesthetic management slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Preoperative management of the pheochromocytoma patient. Without adequate preparation, the release of excessive amounts of catecholamines, especially during anesthetic induction or during surgical removal, can produce lifethreatening cardiovascular complications. Pediatric anesthetic management of the surgical resection. If you continue browsing the site, you agree to the use of cookies on this website. Perioperative management of pheochromocytoma remains an anesthetic challenge. Invasive arterial monitoring should be obtained before induction of anaesthesia. 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.
Pheochromocytoma hypertension treatment open anesthesia. Pheochromocytoma hypertension treatment definition preoperative hypertension treatment. Surgery to remove the tumor is usually the first treatment choice for a paraganglioma, if. Pheochromocytomas are catecholaminesecreting tumors that arise from the chromaffin cells located within the adrenal medulla. This report describes one case of anesthetic management about surgical resection of a malignant phaeochromocytoma with tumor extension. 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. You can manage this and all other alerts in my account. 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. Anesthesia for the adult with pheochromocytoma uptodate. 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. The surgery was uneventfully accomplished with general anesthesia combined with epidural anesthesia. Learn more about the symptoms, causes, treatments, and diagnosis including tests of pheochromocytoma. The observations of deterioration of preoperartive biventricular function that improved significantly postadenalectomy support the diagnosis of catecholamineinduced cardiomyopathy.
Current perioperative management of pheochromocytomas. Pheochromocytoma is pharmacologically volatile, potentially lethal catecholamine containing tumor of chromaffin tissues1. Pheochromocytoma represents very significant challenges to the anesthetist, especially when undiagnosed. Paragangliomas are also catecholaminesecreting tumors arising from extraadrenal chromaffin cells located along the sympathetic paravertebral ganglia of the pelvis, abdomen, and thorax. Symptoms include headache, sweating, palpitations, elevated blood pressure, anxiety, nausea, tremors and more. Vasopressin for hemodynamic rescue in catecholamine. Anesthetic management of gigantic pheochromocytoma resection. Gastrointestinal pseudoobstruction, or paralytic ileus, can be caused by pheochromocytoma with hypersecretion of catecholamines, which act on. They are clinically relevant in perioperative medicine because.
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