Objective

To offer a practical guide for the presurgical and anesthetic management of pheochromocytomas and sympathetic paragangliomas (PGLs).

Methods

This protocol was based on a comprehensive review of the literature and on our own multidisciplinary team’s experience from managing pheochromocytoma and sympathetic PGLs at a referral center.

Results

Patients with pheochromocytomas and sympathetic paragangliomas (PGLs) may develop potentially life-threatening complications, especially during surgical procedures. A complete biochemical, radiological, genetic, and cardiological assessment is recommended in the preoperative stage as it provides an evaluation of the risk of surgical complications and malignancy, allowing individualization of the presurgical treatment. Treatment with α-blockade and proper volume expansion in the preoperative stage significantly reduces the perioperative morbidity. During surgery, the anesthesiologist should look for a deep anesthetic level that inhibits the cardiovascular effects of catecholamines to minimize the risk of intraoperative complications.

Conclusions

An optimal presurgical evaluation of pheochromocytomas/ sympathetic PGL requires a multidisciplinary approach, including a complete hormonal, radiological, cardiac, genetic, and functioning evaluation in most cases. A proper preoperative evaluation in combination with strict blood pressure and heart rate control, and blood volume status optimization, will significantly reduce the risk of intraoperative and perioperative complications. In those patients who unfortunately develop intraoperative complications, the role of the anesthesiologist is essential since the selection of the appropriate management has a direct impact on morbimortality reduction.

中文翻译：

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嗜铬细胞瘤和交感神经副神经节瘤的术前和麻醉管理方案：多学科方法

客观的

为嗜铬细胞瘤和交感神经节瘤 (PGL) 的术前和麻醉管理提供实用指南。

方法

该协议基于对文献的全面回顾以及我们自己的多学科团队在转诊中心管理嗜铬细胞瘤和交感神经 PGL 的经验。

结果

患有嗜铬细胞瘤和交感神经副神经节瘤 (PGL) 的患者可能会出现潜在的危及生命的并发症，尤其是在外科手术期间。建议在术前阶段进行完整的生化、放射学、遗传和心脏病学评估，因为它可以评估手术并发症和恶性肿瘤的风险，从而实现术前治疗的个体化。在术前阶段用α-受体阻滞剂和适当的扩容治疗可显着降低围手术期发病率。在手术过程中，麻醉师应寻找能够抑制儿茶酚胺对心血管影响的深度麻醉水平，以尽量减少术中并发症的风险。

结论

嗜铬细胞瘤/交感神经 PGL 的最佳术前评估需要多学科方法，在大多数情况下包括完整的激素、放射学、心脏、遗传和功能评估。适当的术前评估结合严格的血压和心率控制以及血容量状态优化，将显着降低术中和围手术期并发症的风险。对于那些不幸出现术中并发症的患者，麻醉师的作用至关重要，因为选择适当的治疗方法对降低死亡率有直接影响。