Pheochromocytoma
Conditions
Keywords
Pheochromocytoma, Adrenalectomy, Cardiac output, Fluid managment, Esopagheal doppler sonography
Brief summary
Non-invasive measurements of cardiac output (CO), systemic vascular resistance (SVR), corrected aortic flow time (FTc) and stroke volume (SV) are useful parameters during laparoscopic resection of pheochromocytoma (adrenalectomy) to document the intraoperative changes in volume status and to estimate the volume depletion.
Detailed description
Pheochromocytomas and extraadrenal paragangliomas are catecholamin-producing tumours deriving from the adrenal medulla and sympathetic ganglia. The only causal therapy is surgical resection. Nowadays, laparoscopic adrenalectomy is thought to be the optimal approach. Chronic volume depletion due to chronic hypertension and preoperative α-adrenoreceptor-blockade (to avoid the effects of intraoperative catecholamine-excess) often lead to hypotension after resection of the tumour. Volume reload with high amounts of fluid is often needed. Therefor some authors recommended invasive measurement (pulmonary artery catheter) to control cardiac output parameters and fluid balance. However, there are non-invasive methods to measure cardiac output(CO), systemic vascular resistance(SVR), stroke volume(SV) and corrected aortic flow time(FTc) to estimate volume status. Except transesophageal echocardiography, other techniques such as transoesophageal doppler and pulse pressure methods exist but have not been investigated during surgical therapy for pheochromocytoma so far. The esophageal Doppler currently represents the gold standard for perioperative fluid replacement therapy. The study's hypothesis is that non-invasive measurements of cardiac output (CO), systemic vascular resistance (SVR), corrected aortic flow time (FTc) and stroke volume (SV) are useful parameters during laparoscopic resection of pheochromocytoma (adrenalectomy) to document the intraoperative changes in volume status and to estimate the volume depletion.
Interventions
None listed
Sponsors
Medical University of Vienna
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Planned laparoscopic adrenalectomy for pheochromocytoma (Biochemical confirmed adrenal and extraadrenal pheochromocytoma) * Planned laparoscopic adrenalectomy for hormonally inactive adrenal tumor
Exclusion criteria
* Risk of esophageal bleeding or perforation exists (i.e., liver disease with portal hypertension and/or esophageal varicoses, other esophageal anomalies).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Arterial blood pressure | parameter will be measured continously for the duration of adrenalectomy, an expected average of 3 hours | systolic, diastolic, mean; continuous invasive measurement |
| Central venous pressure | parameter will be measured continously for the duration of adrenalectomy, an expected average of 3 hours | Measured using esophageal doppler |
| Heart rate | parameter will be measured continously for the duration of adrenalectomy, an expected average of 3 hours | — |
| Cardiac output (CO) | parameter will be measured continously for the duration of adrenalectomy, an expected average of 3 hours | measured using esophageal doppler |
| Systemic vascular resistance (SVR) | parameter will be measured continously for the duration of adrenalectomy, an expected average of 3 hours | measured using esophageal doppler |
| Stroke volume (SV) | parameter will be measured continously for the duration of adrenalectomy, an expected average of 3 hours | measured using esophageal doppler |
| Corrected aortic flow time(FTc) | parameter will be measured continously for the duration of adrenalectomy, an expected average of 3 hours | measured using esophageal doppler |
Secondary
| Measure | Time frame |
|---|---|
| Changes in serum concentration: Norepinephrine | 7 timepoints during anesthesia (Administration of rocuronium, intubation, cut, intraabdominal air insufflation, ligature of v. suprarenalis, tumor exstirpation, end of operation) |
| Changes in serum concentration: Dopamin | 7 timepoints during anesthesia (Administration of rocuronium, intubation, cut, intraabdominal air insufflation, ligature of v. suprarenalis, tumor exstirpation, end of operation) |
| Changes in plasma concentration: Metanephrines | 7 timepoints during anesthesia (Administration of rocuronium, intubation, cut, intraabdominal air insufflation, ligature of v. suprarenalis, tumor exstirpation, end of operation) |
| Changes in serum Concentration: Epinephrine | 7 timepoints during anesthesia (Administration of rocuronium, intubation, cut, intraabdominal air insufflation, ligature of v. suprarenalis, tumor exstirpation, end of operation) |
Countries
Austria
Outcome results
None listed