Pheochromocytoma Anesthetic Management

Daniel D. Kim, Christiano Matsui, Judymara L. Gozzani, Ligia A. S. T. Mathias

Anesthesiologist, Santa Casa de Mi- sericordia de Sao Paulo, Sao Paulo, Brazil.
Director of Anesthesiology Service, Santa Casa de Misericordia de Sao Paulo, Sao Paulo, Brazil.
Director of Pain Medicine, Santa Casa de Misericordia de Sao Paulo, Sao Paulo, Brazil.
Resident in Anesthesiology, Santa Casa de Misericordia de Sao Paulo, Sao Paulo, Brazil.

DOI: 10.4236/ojanes.2013.33035                

Abstract

Pheochromocytomas are catecholamine producing tumors and although uncommon present a great challenge to the anesthesiologist since it has nonspecific clinical symptoms and risk of critical events, including death when not previously diagnosed. Clinical manifestation is variable, unspecific and depends on the catecholamine production profile. The classic triad of headache, palpitation and diaphoresis is present in up to 70% of the cases and only 50% have sustained hypertension. The best approach for pheochromocytoma treatment is surgical excision of the affected adrenal gland. The introduction of alpha adrenergic blockade medication, such as phentolamine and phenoxybenzamine had the highest impact in perioperative mortality reduction due to inhibition of the deleterious effect of vasoconstriction. The majority of anesthetic techniques and drugs are considered safe. Post-operative care in intensive care unit is advisable since patients may present instability of blood pressure and hypoglycemia. Genetic testing should be done in first-degree relatives of confirmed cases or when a genetic syndrome is suspected.

Keywords

Pheochromocytoma; Anesthesia Management

Conflicts of Interest

The authors declare no conflicts of interest.

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