Non-invasive Evaluation of Fluid Status and Cardiac Output During Operative Treatment of Pheochromcytoma

• Cardiac output (CO) [ Time Frame: parameter will be measured continously for the duration of adrenalectomy, an expected average of 3 hours ] [ Designated as safety issue: No ]
  measured using esophageal doppler
  
  
• Systemic vascular resistance (SVR) [ Time Frame: parameter will be measured continously for the duration of adrenalectomy, an expected average of 3 hours ] [ Designated as safety issue: No ]
  measured using esophageal doppler
  
  
• Stroke volume (SV) [ Time Frame: parameter will be measured continously for the duration of adrenalectomy, an expected average of 3 hours ] [ Designated as safety issue: No ]
  measured using esophageal doppler
  
  
• Corrected aortic flow time(FTc) [ Time Frame: parameter will be measured continously for the duration of adrenalectomy, an expected average of 3 hours ] [ Designated as safety issue: No ]
  measured using esophageal doppler
  
  
• Central venous pressure [ Time Frame: parameter will be measured continously for the duration of adrenalectomy, an expected average of 3 hours ] [ Designated as safety issue: No ]
  Measured using esophageal doppler
  
  
• Heart rate [ Time Frame: parameter will be measured continously for the duration of adrenalectomy, an expected average of 3 hours ] [ Designated as safety issue: No ]
  
• Arterial blood pressure [ Time Frame: parameter will be measured continously for the duration of adrenalectomy, an expected average of 3 hours ] [ Designated as safety issue: No ]
  systolic, diastolic, mean; continuous invasive measurement
  
  

• Changes in serum Concentration: Epinephrine [ Time Frame: 7 timepoints during anesthesia (Administration of rocuronium, intubation, cut, intraabdominal air insufflation, ligature of v. suprarenalis, tumor exstirpation, end of operation) ] [ Designated as safety issue: No ]
  
• Changes in serum concentration: Norepinephrine [ Time Frame: 7 timepoints during anesthesia (Administration of rocuronium, intubation, cut, intraabdominal air insufflation, ligature of v. suprarenalis, tumor exstirpation, end of operation) ] [ Designated as safety issue: No ]
  
• Changes in serum concentration: Dopamin [ Time Frame: 7 timepoints during anesthesia (Administration of rocuronium, intubation, cut, intraabdominal air insufflation, ligature of v. suprarenalis, tumor exstirpation, end of operation) ] [ Designated as safety issue: No ]
  
• Changes in plasma concentration: Metanephrines [ Time Frame: 7 timepoints during anesthesia (Administration of rocuronium, intubation, cut, intraabdominal air insufflation, ligature of v. suprarenalis, tumor exstirpation, end of operation) ] [ Designated as safety issue: No ]
  

Pheochromocytomas and extraadrenal paragangliomas are catecholamin-producing tumours deriving from the adrenal medulla and sympathetic ganglia. The only causal therapy is surgical resection. Nowadays, laparoscopic adrenalectomy is thought to be the optimal approach. Chronic volume depletion due to chronic hypertension and preoperative α-adrenoreceptor-blockade (to avoid the effects of intraoperative catecholamine-excess) often lead to hypotension after resection of the tumour. Volume reload with high amounts of fluid is often needed. Therefor some authors recommended invasive measurement (pulmonary artery catheter) to control cardiac output parameters and fluid balance. However, there are non-invasive methods to measure cardiac output(CO), systemic vascular resistance(SVR), stroke volume(SV) and corrected aortic flow time(FTc) to estimate volume status. Except transesophageal echocardiography, other techniques such as transoesophageal doppler and pulse pressure methods exist but have not been investigated during surgical therapy for pheochromocytoma so far. The esophageal Doppler currently represents the "gold standard" for perioperative fluid replacement therapy.

The study's hypothesis is that non-invasive measurements of cardiac output (CO), systemic vascular resistance (SVR), corrected aortic flow time (FTc) and stroke volume (SV) are useful parameters during laparoscopic resection of pheochromocytoma (adrenalectomy) to document the intraoperative changes in volume status and to estimate the volume depletion.