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Anaesthetic management of phaeochromocytoma

Canadian Anaesthetists’ Society Journal volume 26, pages 253–259 (1979)Cite this article

Summary

The incidence, mortality, physiology, clinical findings and diagnosis of phaeochromocytoma are reviewed. Treatment, after adequate medical stabilization, must be surgical because of the high incidence of malignancy. Alpha-adrenergic receptor blockade and β-adrenergic receptor blockade in the preoperative period was discussed. Anaesthetic management of patients with phaeochromocytoma requires close monitoring. Virtually all inhalational anaesthetic agents have been used in cases of phaeochromocytoma. Recent reports have favored enflurane. The merits of neuroleptanaesthesia and the various muscle relaxants are also discussed. Most authors favour lidocaine over propranalol for management of dysrhythmias during operation. Phentolamine or sodium nitroprusside are used for hypertension during operation. Hypotension is treated by fluid replacement with nor-epinephrine if a vasopressor becomes necessary. Close monitoring is necessary in the postoperative period. Adequate urinary output is of more importance than actual blood pressure levels.

Résumé

Différents aspects du phéochromocytome sont passés en revue; en particulier, ľincidence, la mortalité, les manifestations cliniques et le diagnostic. Etant donnée ľincidence élevée de malignité, le traitement chirurgical s’impose après stabilisation par une médication appropriée. Le blocage α-adrénergique et β-adrénergique avant ľintervention est discuté. Ľanesthésie exige un monitorage minutieux. A peu près tous les agents inhalatoires ont été employés mais de rapports récents favorisent ľenflurane. Les mérites de la neuroleptanesthésie et des différents myorésolutifs sont présentés. La plupart des auteurs favorisent la lidocaine sur le propanolol pour le contrôle per-opératoire des dysrythmies et la phentolamine ou le nitroprussiate de sodium pour ľhypertension. Ľhypotension se traite par ľapport liquidien et la norépinéphrine si un vaso-presseur devient nécessaire. La période postopératoire demande un monitorage attentif. Un débit urinaire adéquat est plus important que la pression artérielle elle-même.

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Affiliations

  1. Department of Anesthesiology, Mount Sinai School of Medicine, City University of New York, 10029, New York, N.Y., U.S.A.

    Vasilios Pratilas & Margaret G. Pratila

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  1. Vasilios Pratilas
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  2. Margaret G. Pratila
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Pratilas, V., Pratila, M.G. Anaesthetic management of phaeochromocytoma. Canad. Anaesth. Soc. J. 26, 253–259 (1979). https://doi.org/10.1007/BF03006283

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  • DOI: https://doi.org/10.1007/BF03006283

Keywords

  • Succinylcholine
  • Pancuronium
  • Sodium Nitroprusside
  • Enflurane
  • Droperidol