[Lessons learned from anesthetic management of pheochromocytoma resection: a report of three cases].
The anesthetic management of patients with pheochromocytoma, in which drastic hemodynamic changes may occur, is still a challenge to even the most experienced anesthesiologist, although the perioperative mortality has been reduced remarkably. We report three patients who developed unexpected major complications during elective resection of a pheochromocytoma. The Case 1 patient was a 46 year-old woman who developed ventricular tachycardia immediately after administration of ephedrine for transient hypotension induced by excessive phentolamine. Even a mild beta adrenergic agent may cause extraordinary stimulation to myocardium under alpha blockade. The Case 2 patient was a 44 year-old man who needed intensive vasodilating therapy due to an exaggerated cardiovascular response to intraoperative surgical stress. He developed severe metabolic acidosis resembling hyperdynamic shock before resection of the tumor, although blood pressure was controlled within the expected range. The Case 3 patient was a 60 year-old woman who did not receive preoperative alpha blocker therapy because she lacked cardiovascular symptoms. However, she revealed a high level of systemic vascular resistance after induction of general anesthesia and needed moderate inotropic support to compensate for an abrupt reduction of vascular resistance after resection of the tumor. The pathophysiology of the disease is complex and anesthetic care must be tailored in accordance with each patient's situation.
Chang
Kyung-Ho
KH
Department of Anesthesiology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655.
Sugano
Takayuki
T
Hanaoka
Kazuo
K
D000138:Acidosis / Q000209:etiology; D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy; D000328:Adult; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D017558:Elective Surgical Procedures; D004809:Ephedrine / Q000009:adverse effects; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010646:Phentolamine / Q000009:adverse effects; D010673:Pheochromocytoma / Q000601:surgery*; D017180:Tachycardia, Ventricular / Q000209:etiology; D014655:Vascular Resistance
D004809:Ephedrine; D010646:Phentolamine