Anaesthetic management of phaeochromocytoma

The perioperative management of children with phaeochromocytoma

“…Suxamethonium, possibly as a consequence of direct stimulation of sympathetic ganglia or fasciculations provoking catecholamine release, has been associated with large increases in blood pressure ( 21). Tubocurarine has been reported to produce variable effects on blood pressure: sympathetic ganglion blockade and histamine release may produce vasodilatation and hypotension or hypertension may be provoked due to histamine‐induced catecholamine release from the tumour ( 21, 34, 50, 51). Similarly, atracurium through its histamine releasing properties might be theoretically expected to produce unpredictable results but, in practice, has been safely used ( 49).…”

“…Phentolamine is used by some to provide effective,short‐acting control of intraoperative hypertension ( 36, 51, 61). However, its critics point to the fact that its action can be too longlasting (compared to nitroprusside) and there can sometimes be an excessive reflex tachycardia produced ( 34).…”

“…Esmolol, an ultra‐short acting selective antagonist, has been used with great effect in adults ( 52) and children ( 68) to treat both hypertensive surges and dysrhythmias. The commonly used approach to treating intraoperative dysrhythmias has been to use intravenous lidocaine ( 51) or longer acting β‐blockers such as propanolol ( 34). Unfortunately, the use of such agents, in particular long acting β‐blockers, has been associated with instances of severe hypotension most likely due to a significant degree of pre‐existing myocardial dysfunction ( 29).…”

“…Although some patients may remain temporarily hypertensive postoperatively ( 31), despite complete tumour removal, the majority will require correction of hypotension with appropriate fluid replacement. Fluid, sometimes in large quantities ( 4, 78), may be required to correct pre‐existing hypovolaemia, vasodilation due to residual α‐blockade or ongoing fluid losses due to bleeding or ‘third spacing’ following extensive retroperitoneal dissection ( 21, 31, 34, 51, 76).…”

Alpha-and Beta-Adrenoceptor Antagonists

“…Phenoxybenzamine increases the viability of renal cells subjected to periods of interrupted blood flow (Pryor et ah, 1971). The major place for phenoxybenzamine is in the treatment and preoperative preparation of patients suffering from phaeochromocytoma (Sjoerdsma et al, 1966;Pratilas and Pratila, 1979;Desmonts and Marty, 1984), most of the time in association with betaadrenoceptor blockers. Patients with inoperable tumours may be maintained for years on phenoxybenzamine (Engleman and Sjoerdsma, 1964).…”