Abstract
BackgroundPheochromocytoma is a rare catecholamine-secreting tumor. To evaluate the intraoperative hemodynamics with precision is difficult.Case presentationA 42-year-old man, who suddenly developed a life-threatening pheochromocytoma multisystem crisis that occurred during preoperative prophylactic medication, underwent urgent bilateral adrenalectomy. For the purpose of evaluating the intraoperative hemodynamics, we monitored both pulmonary artery catheter-based cardiac output (PACO) and arterial pressure-based cardiac output (APCO; FloTrac™). APCO fluctuated in poor agreement with the change in PACO, especially in the state of cytokine storming.ConclusionsOverall, the value of stroke volume variation derived from FloTrac™ changed in tandem with the intraoperative volume status, indicating its utility as a marker of circulatory hemodynamics.
Highlights
We presented a case of emergent bilateral adrenalectomy following pheochromocytoma multisystem crisis, for which we offered a successful anesthetic management using different types of circulatory monitors
Given that there was an abnormal increase in IL-6 levels, the pulmonary edema could have been attributed to the inflammatory mechanism, by which the overproduction of IL-6 caused from elevated catecholamine levels disrupts the endothelial junction, leading to capillary leakage [6]
The use of arterial pressure-based cardiac output (APCO) would lead to more accurate evaluation of intraoperative hemodynamics, but it turned out that APCO changed rather in poor agreement with pulmonary artery catheter-based cardiac output (PACO)
Summary
With marked elevation in the serum concentration of noradrenaline, accurate estimation of blood pressure and cardiac output is essential for successful anesthetic The use of a pulmonary artery catheter, which directly monitors cardiac output, contributes to the accurate estimation of the cardiovascular status [7, 8]. A less-invasive method for monitoring cardiac output based on the waveform of arterial blood pressure (ABP) has been introduced for clinical use [8].
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