TITLE:
Pheochromocytoma Anesthetic Management
AUTHORS:
Daniel D. Kim, Christiano Matsui, Judymara L. Gozzani, Ligia A. S. T. Mathias
KEYWORDS:
Pheochromocytoma; Anesthesia Management
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.3 No.3,
May
13,
2013
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.