[Fluid loading in the surgical care of pheochromocytoma. Hemodynamic study]

Collapse following removal of pheochromocytoma can be usually prevented by fluid loading. Fluid infusion is administered at the early beginning of the surgical procedure and is accelerated just after removal. Some authors prefer to start the fluid infusion in the preoperative period. In every cases preload measurements are of primary importance for a safely fluid administration. Problems of fluid loading in course of pheochromocytoma surgery are studied in six patients. Hemodynamic data are collected during pre, per and postoperative periods. Pre and post operative rapid fluid loading was performed in three patients in order to obtain a left ventricular function curve. Before any fluid treatment, two groups of patients are distinguished: 1) five hypovolemic patients who are about to receive 1 000 +/- 300 ml to normalize pulmonary wedge pressure, 2) one patient with high pulmonary wedge pressure and with alterated myocardial performance observed during rapid fluid loading. Combined use of sodium nitroprusside and fluid loading allowed to control hypertensive accesses and preload elevations and to prevent collapse following tumor removal. Hypovolemia and myocardial lesions are not necessarily present in all cases of pheochromocytoma. The routine use of a pulmonary artery catheter is warranted to improve cardiac pump function by combined fluid and vasodilator management.