Abstract
Severe hypertension and cardiac arrhythmias are well known problems during surgical removal of pheochromocytoma. This is due to extremely high circulating catecholamines during tumor manipulation. In this study, peroperative blood pressure control was obtained by the infusion of adenosine, which antagonized cardiovascular effects of catecholamines. During operation of 10 patients, none had systolic blood pressure exceeding 200 mm Hg or any cardiac arrhythmias despite extremely high plasma catecholamine levels. A mean blood pressure of 120–150 mm Hg was maintained in all patients. Peroperative use of adenosine seems to be a most effective compound for hemodynamic control during pheochromocytoma surgery.
Résumé
Hypertension sévère at arythmie cardiaque surviennent fréquemment pendant la chirurgie d'exérèse des phéochromocytomes. Ce phénomène est en rapport avec le taux élevé de catécholamines libérées dans la circulation pendant la manipulation tumorale. Dans cette étude, on a contrôlé la tension artérielle peropératoire par une perfusion d'adénosine, antagoniste des effets cardiovasculaires des catécholamines. Pendant l'intervention sur 10 patients, la tension artérielle n'a pas dépassé 200 mm Hg, et il n'y avait aucun cas d'arythmie malgré les taux plasmatiques de catécholamines extrêmement élevés. La tension artérielle moyenne de 120–150 mm Hg était maintenue chez tous les patients. L'utilisation peropératoire d'adénosine semble être efficace dans le contrôle hémodynamique pendant la chirurgie du phéochromocytome.
Resumen
La hipertensión severa y las arritmias cardiacas son dos bien conocidos problemas que pueden presentarse durante la resección quirúrgica de un feocromocitoma. Esto se debe a los muy altos niveles de catecolaminas circulantes que ocurren durante la manipulación del tumor. En el presente estudio se logró un control peroperatorio de la presión arterial mediante la infusión de adenosina, la cual antagoniza los efectos cardiovasculares de las catecolaminas. En el curso de la operación efectuada en 10 pacientes, no se observó, en ninguno de ellos, una presión arterial en exceso de 200 mm Hg o algún tipo de arritmia, a pesar de niveles extremadamente elevados de catecolaminas; se mantuvo una presión media de 120–150 mm Hg en todos los pacientes. El uso peroperatorio de la adenosina parece ser un muy efectivo agente para el control hemodinámico en el curso de la cirugía para feocromocitoma.
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Supported by grants from the Swedish Medical Research Council (02330, and 7445), the Swedish Association Against Heart and Chest Diseases, and the Karolinska Institute.
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Gröndal, S., Bindslev, L., Sollevi, A. et al. Adenosine: A new antihypertensive agent during pheochromocytoma removal. World J. Surg. 12, 581–584 (1988). https://doi.org/10.1007/BF01655854
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DOI: https://doi.org/10.1007/BF01655854