Anesthesia and Pheochromocytoma

Abstract

A 33-year-old woman weighing 108 kg with obesity and neurofibromatosis was presented with a 2-year history of poorly controlled hypertension, headaches, palpitations, and occasional chest pain. Her blood pressure was 170/100 mm Hg, and she was treated with daily oral dose of diltiazem (360 mg), hydrodiuril (12.5 mg), lisinopril (20 mg), and metoprolol XL (25 mg) tablets. Biochemical evaluation for pheochromocytoma showed elevated 24-hour urine metanephrine levels of 5496 mcg and normetanephrine level of 6415 mcg. A computed tomographic scan of the abdomen showed a 6 Â 6-cm right adrenal mass. The remainder of her preoperative tests was otherwise normal. Three weeks before surgery, the patient was started on phenoxybenzamine of 10 mg per day orally, which was gradually increased to 30 mg 3 times a day. The day before the planned surgery, the patient was admitted to surgical floor, her average blood pressure and heart rate were 134/76 mm Hg and 65 bpm, respectively. At midnight, she was given an extra dose of 40 mg of phenoxybenzamine and also received 1 L of 5% dextrose with 0.45% normal saline. The following morning patient was taken to the operating room, standard monitors were

Effectiveness and safety of laparoscopic adrenalectomy of large pheochromocytoma: a prospective, nonrandomized, controlled study

“…1 However, open adrenalectomy (OA) treatment of PCC of adrenal origin represents a particular clinical challenge to surgeons because of the complex nature of the perioperative management that is required. 2 Laparoscopic adrenalectomy (LA) is also technically complex because the adrenal gland bearing the PCC is highly vascularized, 3 and patients are at risk of bleeding and worsening of preexisting hypovolemia in both OA and LA procedures. 4 Laparoscopy has been used for the treatment of solid tumors of the adrenal glands, including PCC.…”

Anesthetic management for resection of para-aortic paraganglioma and unexpected aortic resection: A case report

“…The common agents used are phenoxybenzamine, propanolol and metyrosine, respectively ( 3 , 6 ). Calcium channel blockers have also been used to achieve a better control of BP in addition to α blockade, for patients intolerant to α blockade, and those with intermittent hypertension ( 3 , 7 ). In the present case, the BP of the patient was well controlled with α blockade and β blockade as necessary pre-operatively.…”

Perioperative Management of Severe Hypertension during Laparoscopic Surgery for Pheochromocytoma

“…Sol radyal artere kanül yerleştirildi ve invazif arter basıncı monitörizasyonu yapıldı. (3,4). Ayrıca katekolaminlerin veya α blokerlerin oluşturduğu taşiaritmilerin tedavisi için β blokerlere de ihtiyaç duyulabilir.…”