<abstract xmlns="http://www.w3.org/1999/xhtml">

<p>Perioperative management of pheochromocytoma in the setting of catecholamine-induced heart failure requires careful consideration of hemodynamic optimization and possible mechanical circulatory support. A Jehovah’s Witness patient with catecholamine-induced acutely decompensated heart failure required dependable afterload reduction for a cardio-protective strategy. This was emphasized due to the relative contraindication to perioperative anticoagulation required for mechanical circulatory support. A phenylephrine challenge clearly demonstrated adequate alpha blockade after only 24 hours of phenoxybenzamine treatment. This resulted in advancement of the surgery date. This case also highlights management of beta blockade, volume and salt loading, autologous blood transfusion, and profound post-operative vasoplegia in the setting of cardiogenic shock. Careful attention to hemodynamic optimization and cardio-protective strategies ultimately resulted in positive outcome for this challenging clinical scenario.</p></abstract>

Perioperative management of pheochromocytoma in the setting of catecholamine-induced heart failure requires careful consideration of hemodynamic optimization and possible mechanical circulatory support. A Jehovah’s Witness patient with catecholamine-induced acutely decompensated heart failure required dependable afterload reduction for a cardio-protective strategy. This was emphasized due to the relative contraindication to perioperative anticoagulation required for mechanical circulatory support. A phenylephrine challenge clearly demonstrated adequate alpha blockade after only 24 hours of phenoxybenzamine treatment. This resulted in advancement of the surgery date. This case also highlights management of beta blockade, volume and salt loading, autologous blood transfusion, and profound post-operative vasoplegia in the setting of cardiogenic shock. Careful attention to hemodynamic optimization and cardio-protective strategies ultimately resulted in positive outcome for this challenging clinical scenario.

Pheochromocytoma, Fulminant Heart Failure, and a Phenylephrine Challenge. The Perioperative Management of Adrenalectomy in a Jehovah’s Witness Patient: A Case Report

The Journal of Critical Care Medicine

This work is licensed under the Creative Commons Attribution 4.0 International License.

Perioperative management of pheochromocytoma in the setting of catecholamine-induced heart failure requires careful consideration of hemodynamic optimization...

	Pheochromocytoma	Stress Cardiomyopathy	ADHF
Preoperative	Alpha Blockade	Afterload reduction	Afterload reduction
Optimization	Antiarrhythmic	Antiarrhythmic	Antiarrhythmic/ICD
	Volume loading	Diuretics	Diuretics
	Beta Blockade	Beta blockade/ACEI (chronic	Beta blockade/ACEI (chronic
		stage/recovery) MCS	stage/recovery) MCS

Intraoperative	Afterload reduction Vol-	Afterload reduction	Maintain cardiac output
Hemodynamic Goals	ume resuscitation	Avoid volume overload	Avoid volume overload

Expected Recovery	10 days - 6 weeks	1-4 weeks	Chronic, progressive

Pheochromocytoma, Fulminant Heart Failure, and a Phenylephrine Challenge. The Perioperative Management of Adrenalectomy in a Jehovah’s Witness Patient: A Case Report

Article Category: Case report

Publicado en línea: 13 nov 2021

Páginas: 55 - 60

Recibido: 06 abr 2021

Aceptado: 10 oct 2021

DOI: https://doi.org/10.2478/jccm-2021-0038

Palabras clave
pheochromocytoma, systolic heart failure, stress cardiomyopathy, vasoplegia, bloodless medical and surgical procedures

© 2022 Sarah A. Bachman, Ryan S. Peterson, Peter S. Burrage, Leigh C Hickerson, published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1

Perioperative goals for pheochromocytoma, stress cardiomyopathy, and acute decompensated heart failure [19]

Pheochromocytoma, Fulminant Heart Failure, and a Phenylephrine Challenge. The Perioperative Management of Adrenalectomy in a Jehovah’s Witness Patient: A Case Report

Article Category: Case report

Publicado en línea: 13 nov 2021

Páginas: 55 - 60

Recibido: 06 abr 2021

Aceptado: 10 oct 2021

DOI: https://doi.org/10.2478/jccm-2021-0038

Palabras clavepheochromocytoma, systolic heart failure, stress cardiomyopathy, vasoplegia, bloodless medical and surgical procedures

© 2022 Sarah A. Bachman, Ryan S. Peterson, Peter S. Burrage, Leigh C Hickerson, published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1

Perioperative goals for pheochromocytoma, stress cardiomyopathy, and acute decompensated heart failure [19]

Palabras clave
pheochromocytoma, systolic heart failure, stress cardiomyopathy, vasoplegia, bloodless medical and surgical procedures