Intraoperative management of patients with incidental catecholamine producing tumors: A literature review and analysis

Intraoperative management of patients with incidental catecholamine producing tumors: A literature review and analysis

Blog Article

Context: Present knowledge about intraoperative management, morbidity, and mortality of patients with undiagnosed catecholamine-producing tumors is mostly based on CPAP Pillows published case reports and anecdotal evidence.Aims: The aim was to summarize the management and outcomes of reported cases and analyze for practice patterns, deduct useful management recommendations as applicable.Settings and Design: The Medline database was searched with specific keywords for the period of 1988-2010 for cases of incidental pheochromocytomas and paragangliomas.

Materials and Methods: Case reports in the English language with a postoperative diagnosis of pheochromocytoma and paraganglioma by histopathology were included.Systematic data extraction from case reports was done.Statistical analysis used: Descriptive statistics were applied.

Results: Of 823 retrieved records, 62 case reports met inclusion criteria.Hemodynamic instability occurred primarily during mass manipulation/intraoperatively (52%, n = 32) and induction/laryngoscopy (18%, n = 11).In cases reporting specific High Rise Wide Leg antihypertensive treatments, nitrates (67%, n = 30) represented the majority of medications used, followed by beta-blockers (47%, n = 21).

Alpha receptor blockers were administered in 33% (n = 15).The perioperative mortality was 8% (n = 5), and none of these patients received intraoperative alpha blockade.A catecholamine-secreting tumor was suspected intraoperatively in 26% of cases.

Conclusions: The perioperative mortality based on the reviewed cases of incidental catecholamine producing tumors was less than would traditionally be expected.Intraoperative alpha receptor blockade to treat hypertension was reported in 33% of cases, and none of the patients with a fatal outcome had received it.A higher intraoperative index of suspicion and a lower threshold to consider alpha blocking medications for severe intraoperative hypertension may improve outcomes.