Perioperative and anesthesiological management of patients with pheochromocytoma

Aim. The authors report their experience with adrenalectomy in the treatment of pheochromocytoma, focusing on the perioperative management of the disease. Methods. A comparative analysis of 3 preoperative schemes of cardiovascular therapy is made: Doxazosyn mesilate 8 mg/day, Doxazosyn mesilate 8 mg/day plus Nifedipine 30 mg/day, Doxazosyn mesilate 8 mg/day plus Nifedipine 30 mg/day plus Atenolol 100 mg, all administered along with a proper volemic expansion to minimize vasoconstriction from circulating exceeding cathecolamines and reduce secondary β-stimulation caused by α-blockers. All patiens (n=19) had been admitted to hospital for paroxysmal hypertension, severe headhache, tachycardia, tremors, upper and lower limb paresthesia, polyuria. They all had been submitted, prior to surgery, to serum chemistry, cardiac evaluation, catecholamine and vanil-mandelic acid assay, CT total body and adrenal MIBG scintigram that confirmed the presence of an adrenal neoplasm. Surgery was performed in all patients under general anesthesia, tracheal intubation and controlled mechanical ventilation with Isofluorane, Fentanyl and Vecuronium. Results. The authors discuss the only intraoperative death of a 25year old female patient in the light of the data reported in the literature. Conclusion. The conclusion is drawn that, in spite of the broad consensus on the efficacy of a preoperative cardiovascular therapy, it is still not available an optimal perioperative strategy or a golden standard in the anesthesiologic management, really effective in minimizing the complications of the surgical treatment of pheocromocytoma.