0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Clinical Observation |

Resection of Pheochromocytoma Under Inferior Vena Caval Isolation and Extracorporeal Charcoal Hemoperfusion

Masahiro Tominaga, MD; Yonson Ku, MD; Takeshi Iwasaki, MD; Sanshiro Muramatsu, MD; Yoshikazu Kuroda, MD; Yoriko Shima, MD; Yumiko Takao, MD; Hidefumi Obara, MD
Arch Surg. 1998;133(9):1016-1018. doi:10.1001/archsurg.133.9.1016.
Text Size: A A A
Published online

Resection of pheochromocytoma is associated with potential risks of hypertensive crises and serious arrhythmias due to massive release of catecholamines from the tumor. We report our surgical experience with complete inferior vena caval isolation and extracorporeal charcoal hemoperfusion (IVCI-CHP), which were performed to prevent systemic exposure to catecholamines during surgical manipulation. The IVCI-CHP significantly reduced the postfilter and systemic catecholamine levels compared with the prefilter levels (P<.01), indicating substantial catecholamine extraction (>90%) by the CHP filter. Reflecting the reduction of systemic exposure to catecholamines during IVCI-CHP, the patient's blood pressures were markedly stable. Our findings suggest that IVCI-CHP may be useful to minimize the risk of hypertensive crises during surgical manipulation of pheochromocytoma, by preventing systemic exposure to high levels of circulatory catecholamines.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Place holder to copy figure label and caption
Figure 1.

Schema of inferior vena caval isolation and extracorporeal charcoal hemoperfusion (IVCI-CHP). The inferior vena caval blood is isolated below the hepatic veins with a 3-lumen balloon catheter and directed into the CHP filter by a centrifugal pump (Bio-pump, Bio-Medicus Inc, Minneapolis, Minn) during the tumor manipulation. The arrows indicate the direction of the blood flow in the circuit.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Changes in the plasma norepinephrine concentrations and blood pressures. IVCI-CHP indicates inferior vena caval isolation and extracorporeal charcoal hemoperfusion; A, induction of general anesthesia; B, before initiation of IVCI-CHP; C, after initiation of IVCI-CHP; D, during the tumor manipulation; E, immediately before the tumor removal; F, abdominal closure; G, postoperative day 1; a, intravenous boluses of phentolamine mesylate (10 mg) and nicardipine hydrochloride (2 mg); b, intravenous boluses of phentolamine mesylate (5 mg) and propranolol hydrochloride (2 mg); and c, intravenous boluses of phentolamine mesylate (5 mg) and mexiletine hydrochloride (100 mg).

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 1

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
Jobs
brightcove.createExperiences();