| BackgroundPheochromocytoma is a rare neuroendocrine tumor.Surgical resection is the standard treatment.It presents a challenge to the surgery team because of its clinical features and implications.Also,perioperative management is a great challenge for the anesthesiologists because of dramatic hemodynamic fluctuation and high risk of complications.The patient must be treated before the surgery until a stable hemodynamically state is achieved.The most crucial intraoperative moments are induction of anesthesia and hemodynamic oscillations.An adequate preoperative preparation,modern anesthetic drugs,good collaboration between the surgeons and the anesthesiologists,and postoperative care decrease the rate of complications and improve the outcome.Current evidences show that regional anesthesia is associated with decreased risk of complications after major surgery.However,the effects of combined regional-general anesthesia remain controversial.In this paper,the effects of general anesthesia and general anesthesia combined with continuous epidural block on hemodynamics,postoperative mechanical ventilation time and the occurrence of complications in pheochromocytoma surgery were discussed through meta analysis,in order to provide theoretical basis for the selection of anesthesia in patients with this kind of surgery.MethodsIn this study,the three databases of wanfang,CNKI and PubMed up to June 26,2018 were searched by keywords(Pheochromocytoma and Pheochromocytoma and general anesthesia),following strict inclusion and exclusion criteria.Evaluation contents include:risk assessment of literature bias,mean arterial pressure(MAP)in surgical tumor exploration,heart rate,MAP after tumor resection,time of postoperative ventilation and incidence of complications,and evaluation of publication bias.The statistical analysis was performed with RevMan 5.3.5 software.A random effect model(I2>30%)or fixed effect model(I2>30%)were applied to derive the WMD and corresponding 95%CI with two-sided P values.Statistical significance is set at the a = 0.05 level.ResultsNine CTs(n = 592)were included in this meta-analysis.Significant differences in the MAPs and HR were observed between the 2 groups during tumor exploring[weighted mean difference(WMD)= 9.76,95%confidence interval(95%CI):5.58 to 13.95,P<0.00001,I2=0%]or after resection(MAP,WMD=10.06,95%CI:5.54 to 14.58,P<0.0001,I2=48%;HR,(WMD=7.85,95%CI:0.31 to 15.39,P=0.04,I2=47%).Furthermore,duration of mechanical ventilation(WMD=2.60,95%CI:1.89 to 3.31,P<0.00001,I2=29%)and the rates of post-operative complications exhibited better results than the general anesthesia group after surgery(P=0.002).According to the funnel plot,most measurement indicators have no obvious publication bias.Moreover,no significant differences in the duration of hospital and anesthesia stay were observed between the 2 groups(P>0.05).ConclusionIt can be found from this paper that for pheochromocytoma patients,tumor resection and general anesthesia combined with epidural anesthesia are better than general anesthesia alone.The former can effectively maintain the stability of hemodynamics in the perioperative period,and reduce the postoperative mechanical ventilation time and complications.However,due to limitations in the quality,quantity and sample number of the studies included in this paper,large samples,high-quality clinical randomized controlled studies and relevant basic studies are needed to provide scientific and effective basis for the selection of anesthesia methods for such patients. |
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