ANAESTHETIC MANAGEMENT OF PHEOCHROMOCYTOMAA REVIEW OF 3 CASES

Abstract

INTRODUCTION: Pheochromocytoma is pharmacologically volatile, potentially lethal catecholamine- Containing tumor of chromafn tissues 1 . Pediatric pheochromocytomas, although rare, have an increased incidence of bilateral, multifocal, and familial preponderance when compared to 2 adults. It occurs in less than 2% of pediatric patients with hypertension and is a diagnosis of exclusion . They are usually located in adrenal medulla 3 or sympathetic paraganglia but may be found anywhere chromafn tissue exists. These locations extend from the base of skull to anus . Traditionally it was thought that 90% of pheochromocytoma are found in adrenal medulla and 10% occuredelse where. Prevalence of extra adrenal 4 tumorsis now thought to be as high as 20%.theseare commonly called paragangliomas . RESULT: The child was premedicated with midazolam 30mcg/kg intravenously and was transferred to the operating room on an infusion of normal saline 60 mL/hr and hydrocortisone 10mg/hr according to the endocrinologist's advice. After instituting electrocardiogram (ECG), noninvasive blood pressure (NIBP), and pulse oximeter (SpO2) monitors, the child was pre-oxygenated and anesthesia was induced with propofol2 mg/Kg and fentanyl 2 mcg/Kg. Endotracheal intubation was facilitated with vecuronium0.1 mg/Kg. Right internal juglar vein and right radial artery were cannulated for continuous invasive pressure monitoring. A19G epidural catheter was inserted in T8-T9 interspace for analgesia. CONCLUSION: On the basis of these case reports, we want to emphasize that while dealing with surgeries of pheochromocytomahaemodynamic instability should be kept in mind. Preoperative blood pressure optimization is necessity along with intraoperative beat to beat monitoring and use of titrated doses of antihypertensive accordingly. Persistent hypertension after removal of pheochromocytoma occasionally signies that a residual tumor is present, so post operative biochemical assay and imaging studies are repeated for conrmation and further management.