Clevidipine as an antihypertensive drug in three pheochromocytoma surgeries: Case series
Introduction: Laparoscopic adrenalectomy is the treatment of choice of pheochromocytoma. During the first surgical phase (pneumoperitoneum insufflation, tumor and veins handling), there is a risk of hypertensive crisis due to catecholamine release. After tumor excision, patients can suffer relative vasodilation and the residual effect of antihypertensive drugs, which results in arterial hypotension. For that reason, antihypertensive drugs used in the first phase should have a rapid onset of action, short half-life and no residual effect.
Methods: We report a series of three cases of patients with pheochromocytoma who were treated with laparoscopic adrenalectomy. They all received clevidipine infusion from the beginning of the surgery, before they had presented hypertension, to treat and try to minimize hypertensive peaks.
Results: In all patients, hypertensive peaks were controlled in a few minutes. After tumor resection, clevidipine infusion was stopped in all cases, and any patient required infusion of vasopressors.
Discussion: Clevidipine could be a first choice antihypertensive drug in pheochromocytoma surgery. Starting the infusion of clevidipine before the hypertensive peaks could help to make them less pronounced.
Oleaga A, Goñi F. Feocromocitoma: Actualización diagnóstica y terapéutica. Endocrinol Nutr. 2008; 55(5):202-16. DOI: https://doi.org/10.1016/S1575-0922(08)70669-7
Gardet V, Gatta B, Simonnet G, Tabarin A, Chene G, Ducassou F, Corcuff JB. Lessons from an unpleasant surprise: a biochemical strategy for the diagnosis of pheochromocytoma. J Hypertens 2001;19: 1029–35.
Pacak K, Eisenhofer G, Ahlman H. Bornstein SR, Gimenez-Roqueplo AP, Grossman AB, Kimura N, Mannelli M, McNicol AM, Tischler AS, International Symposium on Pheochromocytoma. Pheochromocytoma: recommendations for clinical practice from the First International Symposium. N Nat Clin Pract Endocrinol Metab 2007; 3(2):92-102. DOI: https://doi.org/10.1038/ncpendmet0396
Tauzin-Fin P, Sesay M, Gosse P, Ballanger P. Effects of perioperative alpha1 block on haemodynamic control during laparoscopic surgery for phaeochromocytoma. Br J Anaesth. 2004;92:512-7. DOI: https://doi.org/10.1093/bja/aeh083
Bénay CE, Tahiri M, Lee L, Theodosopoulos E, Madani A, Feldman LS, Mitmaker EJ. Selective strategy for intensive monitoring after pheocromocytoma resection. Surgery 2016;159:275-83. DOI: https://doi.org/10.1016/j.surg.2015.06.045
Garcia-Orellana M, Rivas G, Farré C, Trillo L. Monitorización hemodinámica con sistema de onda de pulso durante la cirugía del feocromocitoma. Rev Esp Anestesiol Reanim 2014;61(2): 116-117.
Deeks ED, Keating GM, Keam SJ. Clevidipine: a review of its use in the management of acute hypertension. Am J Cardiovascular Drugs 2009;9(2):117-34. DOI: https://doi.org/10.1007/BF03256583
Luis C., Arbonés E., Teixell C., Lorente L., Trillo L. Clevidipino como antihipertensivo en la cirugía de feocromocitoma. Rev Esp Anestesiol Reanim 2018;65(4):225-228. DOI: https://doi.org/10.1016/j.redar.2017.07.001
Kline JP. Use of clevidipine for intraoperative hypertension caused by an undiagnosed pheochromocytoma: A case report. AANA J. 2010;78:288-90. 9.
Bettesworth JG, Martin DP, Tobias JD. Intraoperative use of clevidipine in a patient with von Hippel-Lindau disease with associated pheoch. J Cardiothorac Vasc Anesth. 2013;27:749-51. DOI: https://doi.org/10.1053/j.jvca.2011.12.005
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