Clevidipino como antihipertensivo en la cirugía de feocromocitoma / Clevidipine for hypertension treatment in pheochromocytoma surgery

El feocromocitoma es un tumor productor de catecolaminas y su tratamiento de elección es la adrenalectomía laparoscópica. Durante la insuflación del neumoperitoneo y la manipulación tumoral hay alto riesgo de liberación masiva de catecolaminas y crisis hipertensivas. Tras la exéresis tumoral es frecuente la hipotensión arterial grave por vasodilatación relativa y por el efecto residual de los fármacos antihipertensivos utilizados. Presentamos el caso clínico de un paciente con feocromocitoma intervenido de adrenalectomía laparoscópica. Durante la manipulación quirúrgica hubo un pico hipertensivo brusco que pudo controlarse rápidamente con clevidipino en perfusión. Tras la resección tumoral se detuvo la perfusión y no se produjo hipotensión arterial en ningún momento. El clevidipino es un nuevo antagonista del calcio intravenoso con inicio de acción rápido y vida media corta que no tiene efecto residual y no causa hipotensión tras la resección tumoral, por lo que puede ser un fármaco de primera elección esta cirugía

Pheochromocytoma is a catecholamine-producing tumour and laparoscopic adrenalectomy is its treatment of choice. During pneumoperitoneum insufflation and tumour handling there is a high risk of massive catecholamine release and hypertensive crisis. After tumour excision, severe arterial hypotension is a common effect, due to relative vasodilation and the residual effect of antihypertensive drugs. We report the case of a patient with pheochromocytoma who was treated with laparoscopic adrenalectomy. During surgical manipulation there was a sudden hypertensive peak that could be controlled quickly with clevidipine infusion. After tumour resection, clevidipine perfusion was stopped and there were no arterial hypotension episodes. Clevidipine is a new intravenous calcium antagonist with rapid onset of action and short half-life that has no residual effect and does not produce arterial hypotension after tumour resection. For these reasons, it can be a first-choice drug for this kind of surgery

Clevidipine for hypertension treatment in pheochromocytoma surgery. / Clevidipino como antihipertensivo en la cirugía de feocromocitoma.

Pheochromocytoma is a catecholamine-producing tumour and laparoscopic adrenalectomy is its treatment of choice. During pneumoperitoneum insufflation and tumour handling there is a high risk of massive catecholamine release and hypertensive crisis. After tumour excision, severe arterial hypotension is a common effect, due to relative vasodilation and the residual effect of antihypertensive drugs. We report the case of a patient with pheochromocytoma who was treated with laparoscopic adrenalectomy. During surgical manipulation there was a sudden hypertensive peak that could be controlled quickly with clevidipine infusion. After tumour resection, clevidipine perfusion was stopped and there were no arterial hypotension episodes. Clevidipine is a new intravenous calcium antagonist with rapid onset of action and short half-life that has no residual effect and does not produce arterial hypotension after tumour resection. For these reasons, it can be a first-choice drug for this kind of surgery.