Increased arterial pressure is not predictive of haemodynamic instability in patients undergoing adrenalectomy for phaeochromocytoma C. LENTSCHENER 1 , S. GAUJOUX 2 , J. M. THILLOIS 2 , D. DUBOC 3 , J. BERTHERAT 4 , Y. OZIER 1 and B. DOUSSET 2 1 Department of Anaesthesia and Critical Care, 2 Department of Digestive and Endocrine Surgery, 3 Department of Cardiology and 4 Department of Endocrinology, Universite´ Paris-Descartes, Faculte´ de Me´decine, Assistance Publique – Hoˆpitaux de Paris, Hoˆpital Cochin, Paris, France Background: Pre-operative hypotensive drugs are as- sumed to have dramatically decreased operative mortality and morbidity in patients undergoing phaeochromocy- toma removal only in non-controlled studies. We evalu- ated the predictive value of pre-operative high systolic arterial pressure (SAP) on intra- and post-operative hae- modynamic instability, in 96 patients undergoing laparo- scopic adrenalectomy for phaeochromocytoma. Methods: Ninety-six consecutive patients underwent laparoscopic adrenalectomy for phaeochromocytoma. Pre-operative SAP was not systematically normalised, provided that increased SAP was clinically tolerated. Intravenous nicardipine, esmolol and norepinephrine were intraoperatively titrated to treat SAP increase 4150 mmHg, tachycardia 490–110/min, arrhythmia or SAP decrease under 90mmHg, respectively. Volume ex- panders were not systematically administered. Patients with increased and normal pre-operative SAP were com- pared with respect to (a) nicardipine, esmolol and norepi- nephrine requirement, (b) highest intraoperative SAP and heat rate, (c) lowest intraoperative SAP, (d) duration of surgery and (e) norepinephrine requirement following tumour removal. Results: Groups did not differ significantly with respect to data defined as being indicative of perioperative haemo- dynamic instability (all P values 40.05). Discussion: As previously demonstrated, in patients un- dergoing phaeochromocytoma removal, perioperative haemodynamic changes are mainly due to catecholamine release during tumour manipulation, and to the decrease in catecholamine level following tumour removal. Whether pre-operative hypotensive drugs are likely to alter these changes remains questionable. Conclusion: For most patients scheduled for laparoscopic phaeochromocytoma removal, surgery can be carried out without systematic pre-operative arterial pressure normal- isation. Accepted for publication 2 December 2008 r 2009 The Authors Journal compilation r 2009 The Acta Anaesthesiologica Scandinavica Foundation O PERATIVE mortality following adrenalectomy for phaeochromocytoma has decreased from 45% in the first series to o1% at the present time. 1,2 Various pharmacologic interventions, including the blockade of a-adrenoreceptors, 2–7 b-adrenorecep- tors, 8 calcium channel 9 or catecholamine synthesis 10 are administered pre-operatively and are believed to account for this reduced operative mortality. 3–10 To our knowledge, investigations of the outcome of patients undergoing phaeochromocytoma removal have been based solely on historical comparisons of various hypotensive drug regimens. 3–10 We are aware of only one evaluation showing that high pre-operative arterial pressure was independently correlated with intra- and post-operative non-hyper- tension-related complications in patients undergoing phaeochromocytoma removal. 4 In our institution, some patients free of clinical symptoms such as headache, tinnitus or heart disease did not receive pre-operative hypotensive drugs before surrenalect- omy for phaeochromocytoma. Some others received various hypotensive treatments with inconsistent efficacy. Consequently pre-operative arterial pres- sure was not consistently normalised in these patients. We used data obtained from this large sample of patients to evaluate the predictive value of pre-operative high systolic arterial pressure (SAP) on intra- and post-operative haemodynamic instabil- ity in patients undergoing laparoscopic adrenalect- omy for pheochromocytoma. 522 Acta Anaesthesiol Scand 2009; 53: 522–527 Printed in Singapore. All rights reserved r 2009 The Authors Journal compilation r 2009 The Acta Anaesthesiologica Scandinavica Foundation ACTA ANAESTHESIOLOGICA SCANDINAVICA doi: 10.1111/j.1399-6576.2008.01894.x