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Anesth Analg 2006;102:637-641
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000184816.00346.65

GENERAL ARTICLES

Laparoscopic Approach to Pheochromocytoma: Is a Lower Intraabdominal Pressure Helpful?

Jayashree Sood, MD, FFARCS*, Lakshmi Jayaraman, MD, DA.*, Ved P. Kumra, MD, DA*, and Pradeep K. Chowbey, MS, MNAMS, FIMSA, FAIS, FICS{dagger}

Department of *Anaesthesiolgy, Pain & Perioperative Medicine; and {dagger}Department of Minimal Access Surgery, Sir Ganga Ram Hospital, New Delhi, India

Address correspondence and reprint requests to Jayashree Sood, MD, Flat 507, Adishwar Apartments, 34 Ferozeshah Road, New Delhi 110 001, India. Address e-mail to jayashreesood{at}hotmail.com.

Laparoscopic adrenalectomy is gaining popularity because of its well-documented benefits. The aim of our study was to see if a decreased intraoperative intraabdominal pressure during laparoscopic adrenalectomy would affect the hemodynamic variables and the serum levels of catecholamines. We randomly divided 9 patients into 2 groups, maintaining either an intraabdominal pressure of 15 mm Hg (group A) or 8–10 mm Hg (group B). Norepinephrine and epinephrine blood levels were measured preoperatively, during endotracheal intubation, carboperitoneum, surgical manipulation of tumor just before the ligation of the adrenal vein, and tracheal extubation; the hemodynamic variables were recorded. The introduction of carboperitoneum resulted in an increase in heart rate and mean arterial blood pressure (MAP), although it was statistically insignificant. The norepinephrine levels showed a statistically significant increase in group A as compared with group B (P = 0.0002). Surgical manipulation of the tumor resulted in a significant increase in MAP and norepinephrine levels in group A (P = 0.007 and P = 0.0001, respectively). The epinephrine levels did not change as much because the tumor was probably predominantly norepinephrine-secreting. Norepinephrine levels continued to be high even during tracheal extubation in group A patients (P = 0.027). We conclude that a low intraabdominal pressure of 8–10 mm Hg causes less catecholamine release and fewer hemodynamic fluctuations.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2006 by the International Anesthesia Research Society.