THE ANAESTHETIC MANAGEMENT Of patients with pheochromocytoma has become increasingly sophisticated in recent years, thanks to the introduction of a variety of drugs which allow selective inhibition of responses to abnormally high levels of circulating catecholamines. Preoperative and intraoperative alpha and beta adrenergic block, improved intraoperative monitoring, fluid and blood infusion therapy, and employment of anaesthetic agents which do not sensitize the myocardium to circulating catecholamines have all contributed to reducing the dangers of uncontrollable hypertension and serious cardiac arrhythmias during removal of these tumours.The following ease report describes our recent experience with a patient with pheochromocytoma and illustrates the principles of management advocated in the current medical literature.
CASE l~voaxA 43-year-old woman was referred to the University of Rochester Medical Center with a presumptive diagnosis of pheochromocytoma. Though intermittently hypertensive for ten years, she had become persistently hypertensive during the year prior to admission. Additional symptoms included nervousness, increased perspiration, episodes of palpitations, decreased vision in the right eye, slight weight loss, and one episode of "vascular headache." Further history revealed that the patient's mother had suffered from hypertension and a "stroke," and two of her sisters were said to be suffering from hypertension. Physical examination revealed a well-developed, alert, co-operative white female, whose blood pressure was 200,/125 mm Hg and pulse rate 72 beats per minute. The maximum recorded blood pressure preoperatively was 250/160 mm Hg. Other physical findings included a fine tremor of the outstretched hands, bilateral retinopathy with papilloedema, and a right upper quadrant abdominal mass. No Cushingoid features were present.Laboratory findings. The admission haemogram (haematocrit 39 per cent), blood urea nitrogen, serum electrolytes, serum glutamic oxalacetic transaminase, and alkaline phosphatase levels were within normal limits. The fasting blood sugar level was 169 mg per 100 ml, and the glucose tolerance test levels were elevated.
