Anesthetic management for laparoscopic pheochromocytoma resection in a patient with cardiac dysfunction under dynamic monitoring

A 51-year-old women with cardiac dysfunction due to catecholamine-induced cardiomyopathy underwent laparoscopic adrenalectomy for pheochromocytoma. Her preoperative cardiac status was New York Heart Association (NYHA) class IIand left ventricular ejection fraction (LVEF) was 45%. In her anesthetic m...

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Bibliographic Details
Published inMasui. The Japanese journal of anesthesiology Vol. 63; no. 10; p. 1111
Main Authors Yamaguchi, Satoshi, Hirakawa, Kei, Kitamura, Jiro, Ienaga, Toshiki
Format Journal Article
LanguageJapanese
Published Japan 01.10.2014
Subjects
Adrenal Gland Neoplasms - complications
Adrenal Gland Neoplasms - secretion
Adrenal Gland Neoplasms - surgery
Adrenalectomy
Anesthesia - methods
Arterial Pressure
Cardiac Output
Cardiomyopathies - diagnosis
Cardiomyopathies - etiology
Catecholamines - adverse effects
Catecholamines - secretion
Female
Hemodynamics - physiology
Humans
Intraoperative Care
Laparoscopy
Middle Aged
Monitoring, Intraoperative - instrumentation
Monitoring, Intraoperative - methods
Pheochromocytoma - complications
Pheochromocytoma - secretion
Pheochromocytoma - surgery
Stroke Volume
Vasodilator Agents - administration & dosage
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Summary:A 51-year-old women with cardiac dysfunction due to catecholamine-induced cardiomyopathy underwent laparoscopic adrenalectomy for pheochromocytoma. Her preoperative cardiac status was New York Heart Association (NYHA) class IIand left ventricular ejection fraction (LVEF) was 45%. In her anesthetic management, we used FloTrac® system and monitored arterial pressure-based cardiac output (APCO) and stroke volume variation (SVV) continuously as the indicator of intraoperative hemodynamics. Although her hemodynamics fluctuated highly during manipulation of the tumor and after ligation of adrenal vein intraoperatively, we could manage them rapidly by adjusting administration of vasodilator or pressor agents and appropriate volume expansion under monitoring APCO and SVV. The operation was completed successfully and postoperative course was almost uneventful. As laparoscopic pheochromocytoma resection is accomplished in a brief period with less surgical invasion compared with laparotomy, it may be possible to manage hemodynamics of the patient with cardiac dysfunction properly under dynamic monitoring using FloTrac® system.
ISSN:0021-4892