Anesthesia for Pheochromocytoma and Glomus Jugulare
Pheochromocytomas (PCCs) are hormonally active adrenal tumors that secrete supraphysiologic levels of catecholamines resulting in chronic sympathetic stimulation. Patients most commonly present with signs and symptoms of adrenergic excess such as paroxysmal hypertension, tachycardia and headache. Alternatively, these tumors may be discovered as incidental masses on abdominal imaging. Surgical resection is currently the only definitive treatment for PCC; it does however, carry the risk of provoking severe intraoperative hemodynamic instability. Perioperative anesthetic considerations for pheochromocytoma resection include adequacy of preoperative adrenergic blockade and volume resuscitation, invasive hemodynamic monitoring, and the anticipation, mitigation and treatment of intraoperative sympathetic stimulation. Current practice guidelines for patient optimization and perioperative management are based largely on retrospective cohort data, as little prospective research is available in the existing literature.
KeywordsPheochromocytoma Paraganglioma Adrenalectomy Alpha blockade Phenoxybenzamine Metyrosine Hypertensive crisis Adrenal excess Catecholamines
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