Peculiarities of anesthesia for the surgical treatment of pheochromocytoma: About a case

This study decribes the treatment of a 37-year old female patient, with a history of poorly treated arterial hypertension (AH), referred to surgical consultation with right lower back pain, vertigo, headache, sweating and palpitations. During hospitalization, blood pressure (BP) ranged between 130/80 mm Hg and 190/120 mm Hg. The remainder of the clinical examination was normal. Thoracoabdominal scanner showed adrenal mass measuring 55x45x65 mm compressing the inferior vena cava and the right renal vein. The assay of urinary vanilmandelic acid (VMA) was 11.8mg/24hours. The assay of catecholamines in the blood was not performed. The diagnosis of pheochromocytoma was retained and surgical indication was determined. During pre-anaesthesia consultation, clinical examination showed good general condition, blood pressure (BP) to190/120 mmHg, normal cardiopulmonary auscultation and prediction criterion of easy intubation (Mallampati II). The patient underwent preoperative treatment with alpha-blockers and beta-blockers, and calcium channel blocker. Adrenalectomy was performed using midline laparotomy. The patient didn?t have hemodynamic instability during mobilization and tumor resection. The postoperative course was uneventful. She was discharged home on postoperative day 7. At 3 months? follow-up, the patient had no clinical signs and blood pressure was normal. Anesthesia for the surgical treatment of pheochromocytoma is feasible even in resource-limited settings. An adequate preoperative preparation of the patient helps prevent complications.