[Anesthetic management in pheochromocytoma]

Abstract

Consequent preoperative alpha-receptor blockade, as well as improved surgical technique, anaesthetic management and monitoring have reduced perioperative mortality below 3%. Nevertheless, serious problems are still to be expected during the resection of "complicated" pheochromocytoma. "Complicated" in this context means one or more of the following conditions: missing preparation, severe technical surgical difficulties (e.g. location in the liver), concomitant disorders (e.g. coronary arterial disease), pregnancy and/ or great consequential damages (e.g. cardiomyopathia). Therapy of hemodynamic crisis during "complicated" resection of pheochromocytoma requires differentiated pharmacological combinations considering concomitant disorders. For instance multiple various combinations of phenoxibenzamine, natriumuitropussid, adenosine, magnesiumsulphate, esmolol, diltiazem have been used successfully in concomitant coronary art disease. Absolute preferences are not established. Similarly in the anaesthetic management, a determination of a preferred procedure is still missing. All anaesthetic possibilities should be used carefully directed with two aims: first minimise indirect release of catecholamines through effective vegetative damping and prevention of stress; second to support therapy of hemodynamic crises through ingenious use of effect and side effects of the anaesthetic drugs. Experiences and excellent cooperation between surgery, endocrinology and anaesthesiology are essential for successful prevention of perioperative complications.