Abstract
Purpose
To date, no monitoring has proved its usefulness for both interpretation and treatment of arterial hypotension following pheochromocytoma resection. In this prospective observational study we measured the negative component (Δdown) of the respiratory systolic pressure variation in order to assess its ability to guide fluid therapy in 13 patients undergoing pheochromocytoma surgery.
Methods
The arterial pressure waveform was recorded via a 20-g radial artery catheter. Δdown was measured during abdominal exploration (baseline), after fluid loading, before and following tumour resection, and during treatment of arterial hypotension.
Results
At baseline, Δdown ranged between I and 15 mmHg (median: 3 mmHg). Volume loading (500 mL colloid over 20 min) performed during abdominal exploration significantly reduced Adown (P = 0.001) and resulted in Adown values ≤ 2 mmHg in all 13 patients. The Δdown measured immediately before resection was larger in patients who had arterial hypotension (systolic arterial pressure (SAP) < 90 mmHg) following tumour removal than in other patients [4 (1–10)vs 1 (0–3) mmHg;P = 0.04], During hypotension, Δdown was greater in patients where fluid replacement restored SAP than in patients where fluids were ineffective and vasopressors needed [Δdown: 4 (3–9)vs 1 (1–2) mmHg;P = 0.03].
Conclusion
During pheochromocytoma surgery, a Δdown ≤ 2 mmHg appears to indicate minimal intravascular volume depletion. Δdown measurements could be used to guide fluid therapy for the prevention and treatment of arterial hypotension following pheochromocytoma removal.
Résumé
Objectif
Aucun monitorage n’est encore utile à l’interprétation et au traitement de l’hypotension artérielle qui suit la résection d’un phéochromocytome. Pendant notre étude prospective par observa-tion, nous avons mesuré la composante négative (Δdown) de la variation de la pression systolique respiratoire afin d’évaluer sa capacité à guider le remplissage vasculaire chez 13 patients opérés pour un phéochromocytome.
Méthode
La pression artérielle a été enregistrée au moyen d’un cathéter artériel radial de calibre 20. Le Δdown a été mesuré pendant l’exploration abdominale (mesure de base), après la charge liquidienne, avant et après la résection tumorale et pendant le traitement de l’hypotension artérielle.
Résultats
Au départ, le Δdown se situait entre 1 et 15 mmHg (médiane : 3 mmHg). La charge volumique (500 mL de colloïde pendant 20 min) réalisée pendant l’exploration abdominale a significativement réduit le Δdown (P = 0,001) et entraîné des valeurs ≤ 2 mmHg chez les 13 patients. Le Δdown mesuré immédiatement avant la résection a été plus important chez les patients qui avaient de l’hypotension artérielle (pression artérielle systolique (PAS) < 90 mmHg) après le retrait de la tumeur que chez les autres patients [4 (1–10) vs 1 (0–3) mmHg; P = 0,04]. Pendant l’hypotension, le Δdown était plus marqué pour les patients chez qui le remplacement liquidien a restauré la PAS que pour les patients où les liquides ont été inefficaces et les vaso-presseurs nécessaires [Δdown : 4 (3–9) vs 1 (1–2) mmHg; P = 0,03].
Conclusion
Pendant la résection d’un phéochromocytome, un Δdown ≤ 2 mmHg semble indiquer une déplétion minimale du volume des liquides intravasculaires. Les mesures du Δdown peuvent guider le remplissage vasculaire utilisé comme prévention et traitement de l’hypotension artérielle suivant la résection d’un phéochromocytome.
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Mallat, J., Pironkov, A., Destandau, MS. et al. Systolic pressure variation (Δdown) can guide fluid therapy during pheochromocytoma surgery. Can J Anesth 50, 998–1003 (2003). https://doi.org/10.1007/BF03018362
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DOI: https://doi.org/10.1007/BF03018362