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An increased circulating blood volume does not prevent hypotension after pheochromocytoma resection

[Une augmentation du volume du sang circulant ne prévient pas l’hypotension après la résection d’un phéochromocytome]

From the Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan.

Address correspondence to: Dr. Takehiko Iijima, Department of Anesthesiology, Kyorin University, 6-20-2 Shinkawa Mitaka-City, Tokyo 181, Japan. Phone: +81-422-47-5511 ext. 2410 or 3544; Fax: +81-422-43-1504; E-mail: iijmt{at}kyorin-u.ac.jp

Purpose: Pulse dye-densitometry, a novel monitor that measures circulating blood volume (CBV) and cardiac output (CO), was used in patients with pheochromocytoma to determine the relationship between CBV and post resection hypotension.

Methods: Case control study. An blocker was administered for approximately two weeks, and its effect on the expansion of CBV was quantified. CBV was monitored in seven patients admitted for resection of suspected pheochromocytoma before preoperative -blocker therapy, after -blocker therapy and three times during the operation. Relationships between the CBV and blood pressure after resection of the tumour were examined.

Results: CBV increased from 72.0 ± 10.0 mL•kg^-1 to 83.4 ± 12.2 mL•kg^-1 after blockade. (P < 0.001). We found a significant inverse relationship between the increase in CBV after -blocker therapy and blood pressure after resection of the tumour.

Conclusions: Expansion of the CBV by -blocker therapy was related to lower blood pressures after resection of the pheochromocytoma. Expansion of the CBV by an blocker may have increased the elastance of blood vessels. Preoperative blood volume expansion does not preclude hypotension after tumour resection. Although the CBV value itself is not a predictor for hypotension after tumour resection, pulse dye-densitometry provides values of CO and CBV simultaneously, assisting in the management of volume resuscitation and/or the need for catecholamines.