Volume : 9, Issue : 2, February - 2020

Anaesthetic challenges & management of a patient for pheochromocytoma excision Case report

Dr Ishaan Dubey, Dr Alpa Patel, Dr Birva Khara

Abstract :

Background: Pheochromocytoma is a rare catecholamine producing tumor of the adrenal gland. The anaesthetic management of the tumor can be challenging because of hemodynamic fluctuations encountered preoperatively, during induction of anaesthesia, manipulation of tumor & after the excision. Objective: To report perioperative anaesthetic management of a 63-year old female with pheochromocytoma for surgical excision, the major challenges were uncontrolled hypertension, diabetes with history of ischaemic heart disease. Method: Combined general and epidural anaesthesia was used in this patient. Preoperatively, the patient presented with high blood pressure which was adequately controlled with alpha and beta blockers. Intra- operatively she developed severe hypertension during manipulation of the tumor which was managed pharmacologically with nitroglycerin, esmolol, magnesium sulphate & epidural anaesthesia while hypotension that developed after the excision of the tumor was managed with intravenous fluid, packed cell volume and noradrenaline. Post operatively she was transferred to intensive care unit for monitoring and pain management and she made an uncomplicated recovery. Conclusion Pheochromocytoma is a rare tumor with its management being challenging and patient is at significant risk for major adverse cardiac as well as neurological complications. Successful management requires careful preoperative optimization, intra operative planning, post operative close supervision and hemodynamic management with thorough knowledge of the physiology & pharmacology of drugs will lead to good outcome.