Intrathoracic blood volume during laparoscopic adrenectomy for primary aldosteronism under general anesthesia

We used PiCCO™ (Pulsion Ltd) device to measure the intrathoracic blood volume by transpulmonary thermodilution method in order to estimate infusion rate in patients undergoing laparoscopic adrenectomy for primary aldosteronism. A systemic blood volume in patients with primary aldosteronism might increase by an oversecreted aldosteron and the patients usually suffer from hypertension, because of increasing systemic blood volume. During anesthesia, we should carefully perform fluid therapy in order not to cause pulmonary edema. After anesthesia induction, the intrathoracic blood volume increased. And, during surgery, the blood epinephrine concentration increased due to direct tumor manupulation by surgeon, leading to induced hypertension. Because of induced hypertension, it was difficult to estimate the systemic blood volume. Under these conditions, PiCCO™ device was a useful monitor to estimate the systemic blood volume during surgery in patients with primary aldosteronism.