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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.
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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.

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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.

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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).

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