APCO Guide Fluid Therapy Feasibility Study Of Pheochromocytoma Resection Laparoscopic Addicted

Background:Pheochromocytoma is a neuroendocrine tumor excreting excessive catecholamines, which can cause severe hypertension, potentially lethal cardiovascular complications and significant hemodynamic changes during Iaparoscopic resection of pheochromocytoma. Traditional hemodynamic monitoring including blood pressure, heart rate, urine output, central venous pressure, has been demonstrate less accurately reflecting the intravascular volume status. The recently introduced APCO (cardiac output monitoring by arterial pressure waveform) system allows the cardiac output to be measured continuously using a peripheral arterial line. The stroke volume variation (SVV) determined by APCO has been verified as a reliable predictor of fluid responsiveness.Objective:Our research aims to discuss the practicability of hemodynamic monitoring and fluid management guided by APCO in laparoscopic resection of pheochromocytoma.Method:In this randomized controlled trial,26patients scheduled for laparoscopic resection of pheochromocytoma were included. In APCO group, hemodynamic variables, serum lactate, ScvO2were measured before/after position changed, pneumoperitoneum, tumor manipulation and tumor removed. SVV>13%indicates fluid administration. Otherwise, hemodynamic stability is maintained by vasoactive agents. In control group, standard fluid management was applied.Results:MAP,CI,SVRI significantly increased after pneumoperitoneum and tumor manipulation, decreased after tumor removed. SVV showed a valid reduction after colloid infusion, while an excessive high value during tumor manipulation. Compared with control group, APCO group had fewer colloid infusion, lower lactate concentration and shorter ICU stay.Conclusion:It’s feasible for hemodynamic monitoring and fluid management assessed by APCO in laparoscopic resection of pheochromocytoma, despite limitations during the phase of dramatic hemodynamic changes due to catecholamines releasing or vasodilators administration. On the premise of stable vascular tone, SVV as the predictor of fluid responsiveness can ensure adequate issue perfusion.