The Anesthetic Managements Of Pheochromocytoma Resection(a26Cases Report)

Objective: To explore the anesthetic methods and managements ofpheochromocytoma resection and identify preoperative risk factors for intraoperativehemodynamic instability，in order to improve the intraoperative security.Methods: Twenty-six patients with an elective pheochromocytoma resection receivedphenoxybenzamine, amlodipine, propranolol or metoprolol for1~3weeks and fluidinfusion for3~5days before surgery. All patients had an open or laparoscopicpheochromocytoma resection under general anesthesia, the anesthetic methods,monitorings and using of vasoactive drugs during intraoperation were retrospectivelyanalyzed. Hemodynamic instability was assessed by measuring the frequency ofhypertensive(SBP>160mmHg) and/or hypotensive(MAP<60mmHg) episodes,analysed the correlation between hemodynamic instability and the sex, age, weight,preoperative plasma catecholamine concentration, tumor diameter, type of operation.Results: All patients had the tumors removed successfully because of sufficientpreoperative preparation and timely,effective anesthetic managements.They recoveredwell without any anesthetic complications. A positive correlation was found betweenthe intraoperative frequency of hypertensive episodes and plasma NE concentration(r=0.423,P<0.05), the frequency of hypotensive episodes was positively correlated toplasma NE concentration(r=0.484,P<0.05) and tumor diameter (r=0.570,P<0.01). Thesex, age, weight, plasma E concentration and type of operation were not related to theintraoperative frequency of hypertensive or hypotensive episodes.Conclusions: Fully preoperative preparations and reasonable anesthetic managementsare the keys to the success of the pheochromocytoma resection. Risk factors forintraoperative hemodynamic instability during surgery for pheochromocytomaresection include plasma NE concentration and tumor size.