Abdullah OĞUZ, Abdulmenap GÜZEL, Hakan AKELMA, Erdal DOĞAN, Zeynep YILDIRIM BAYSAL, Gönül KAVAK ÖLMEZ, Haktan KARAMAN

Laparoskopik feokromasitoma cerrahisinde anestezi yönetimi: Olgu sunumu

Feokromasitoma adrenal medulla kromafin hücreleri kaynaklı nöroendokrin bir tümördür. Hipertansiyon, baş ağrısı, terleme, çarpıntı ve anksiyete gibi semptomlar gösteren değişken bir kliniğe sahiptir. Tanıda idrarda vanilmandelik asit ve metanefrinlerin tayini en duyarlı test olarak kabul edilmektedir. Tümörün lokalizasyonunun belirlenmesinde bilgisayarlı tomografi ve magnetik rezonans görüntüleme kullanılabilir. Anestezi indüksiyonu ve cerrahi manipulasyonlar katekolaminlerin katastrofik salınımına yol açmaktadır. Bu nedenle doğru preoperatif farmakolojik hazırlık bu hastalarda hayati önem taşımaktadır. Tedavi, ?-blokörlerle tehlikeli hemodinamik dalgalanmayı engelledikten sonra primer tümörün ve mümkün ise metastazların tam cerrahi rezeksiyondur. Günümüzde laparoskopik adrenalektomi birçok adrenal kitlede standart tedavi yöntemi olarak açık cerrahinin yerini almaya başlamıştır.

Anesthetic management of laparoscopic pheochromocytoma surgery: A case report

Pheochromocytoma is a neuroendocrine tumor of the adrenal medulla chromaffin cells. It has a variable clinic indicating symptoms such as hypertension, headache, sweating, palpitations, and anxiety. Determination of vanillylmandelic acid in urine and metanephrines are accepted as the most sensitive tests for diagnosis. Computerized tomography and magnetic resonance imaging cad be used for tumor localization. Anesthetic induction and surgical manipulations usually lead to the catastrophic release of catecholamines. Thus, accurate preoperative pharmacological preparation is vital in these patients. Treatment is a complete surgical resection of the primary tumor and, if possible, metastases after banning dangerous fluctuations in hemodynamic through ?-blockers. Today, laparoscopic adrenalectomy has begun to replace open surgery as a standard treatment method in many adrenal diseases.

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Yuan Shaoa, M, Ran Chena, M, Zhou-jun Shena, et al. Preoperative alpha blockade for normotensive pheochromocytoma: is it necessary? J Hypertension 2011;29:2429-2432.
Kurt E, Ayaz Y. Adrenal Sistem ve Anestezi. Turkiye Klinikleri J Anest Reanim-Special Topics 2008;1:53- 67.
Michelle A.O. Kinney, Bradly J. Narr, and Mark A. Peri- operative Management of Pheochromocytoma. J Car- diothor and Vasc Anesth 2002;16:359-369.
Hull CJ. Pheochromocytoma: diagnosis, preoperative preparation, and anaesthetic management. Br J An- aesth 1986;58:1453-1468.
Kinney MA, Narr BJ, Warner MA. Perioperative man- agement of pheochromocytoma. J Cardiothorasc Vasc Anesth 2002;16:359-369.
Pyrs-Roberts C.Phaeochromocytoma-recent progress in its management. Br J Anaesth 2000; 85;44-57.
Dımıtrıou V, Chantzi C, Zogogiannis I, et al. Remi- fentanyl preventing hemodynamic changes during laparoscopic adrenalectomy for pheochromocytoma. Middle East J Anesthesiol 2006;18:947-954.
Minto C, Schnider TW, Egan TD, et al. Influence of age and gender on the pharmacokinetics and pharmaco- dynamics of remifentanil. Anesthesiology 1997;86:10- 23.
Casati A, Albertin A, Faneli G, et al. A comparison of remifentanil and sufentanil as adjuvants during sevo- flurane anesthesia with epidural analgesia for upper abdominal surgery. Anesth Analg 2000;91:1269-1273.
Gagner M, Lacroix A, Bolté E. Laparoscopic adrenal- ectomy in Cushing's syndrome and pheochromocy- toma. N Engl J Med 1992;327:1033.
Fernandez-Cruz L, Taura P, Saenz A, et al. Laparo- scopic approach to pheochromocytoma: Hemody- namic changes and catecholami nesecretion. World J Surg 1996;20:762-768.
Hull CJ. Pheochromocytoma: diagnosis, preoperative preparation, and anaesthetic management. Br J An- aesth 1986;58:1453-1468.
Schif RL, Welsh GA. Perioperative evaluation and management of the patient with endocrine dysfunc- tion. Med Clin N Am 2003;87:175-192.