Tanaka Yuto, Sumie Makoto, Hashimoto Takuma, Osawa Sayaka, Karashima Yuji, Kandabashi Tadashi, Yamaura Ken
Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
Department of Anesthesia, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan.
JA Clin Rep. 2023 Mar 10;9(1):13. doi: 10.1186/s40981-023-00605-z.
Anesthetic management of pheochromocytoma and paraganglioma with Fontan circulation is challenging for physicians, with attention to cardiovascular physiology.
We performed anesthetic management for pheochromocytoma and paraganglioma in three patients with Fontan circulation. We maintained intraoperative central venous pressure at preoperative level under fluid infusion and administrating nitric oxide to decrease pulmonary arterial resistance. We administered noradrenaline or vasopressin if low blood pressure was present despite adequate central venous pressure. Although noradrenaline is prevalent for the case of noradrenaline-secreting tumor especially after resection, we could maintain blood pressure to administrate vasopressin without increasing central venous pressure. Retroperitoneal laparoscopic approach which could avoid intra-abdominal adhesions might be selectable as case 3.
Sophisticated management is required for pheochromocytoma and paraganglioma with Fontan circulation.
对于患有Fontan循环的嗜铬细胞瘤和副神经节瘤患者进行麻醉管理对医生来说具有挑战性，需要关注心血管生理学。
我们对三名患有Fontan循环的嗜铬细胞瘤和副神经节瘤患者进行了麻醉管理。在液体输注并给予一氧化氮以降低肺动脉阻力的情况下，我们将术中中心静脉压维持在术前水平。如果尽管中心静脉压足够但仍出现低血压，我们会给予去甲肾上腺素或血管加压素。尽管去甲肾上腺素在分泌去甲肾上腺素的肿瘤病例中尤其是切除术后很常见，但我们可以通过给予血管加压素来维持血压而不增加中心静脉压。对于病例3，可选择能避免腹腔粘连的腹膜后腹腔镜手术入路。
对于患有Fontan循环的嗜铬细胞瘤和副神经节瘤，需要进行精细的管理。
