Anesthetic Management of Pediatric Patient with Pheochromocytoma: A case report / 대한마취과학회지

Pheochromocytoma is an unusual tumor in pediatric age group and there are several different aspects from adult counterparts. Children have fewer malignant, more extra-adrenal, and greater bilaterality and multiplicity of tumor. We present a case of 14-year old boy with pheochromocytoma who has symptoms such as episodic headaches, vomiting, seizure and paroxysmal hypertension which is less common in children. Although the duration of preoperative preparation was not long enough, we decided to remove the tumor because symptoms were disappeared rather rapidly after alpha and beta adrenergic blocker treatment. The patient was managed with continuous epidural block and light general anesthesia but extra use of adrenergic receptor blocker and vasodilator were demanded during tumor manipulation. The patient has remained well postoperatively but long-term follow up is essential because of the possibilities of recurrence.

Hypotension Controlled by Infusion of Norepinephrine during Pheochromocytoma Excision: Case report / 대한마취과학회지

We report a case in which a 63-year-old male patient with pheochromocytoma developed persistent hypotension during surgery despite rapid volume replacement and administration of vasopressors. The patient was prepared for surgery with phenoxybenzamine for 13 days. Anesthesia was induced with thiopental sodium and maintained with N2O, O2, and enflurane. Sodium nitroprusside (SNP) was initiated and titrated based upon intraarterial blood pressure. Hypertensive episode during tumor manipulation was effectively managed by increased infusion of SNP. After surgical removal of tumor, this patient developed profound hypotension, which was aggressively managed by intravenous administration of crystalloid and blood as well as dopamine and epinephrine. However, this hypotension was persistent and aggravated. Accordingly, Infusion of norepinephrine (Levophed(R))was started and then the patient recoverd from his hemodynamic aberrations. We conclude that the cause of the persistent hypotension was cumulative and residual effect of preoperative phenoxybenzamine. Therefore, norepinephrine should be readily available for the treatment of hypotension resistant to other pharmacologic interventions.

We Anesthetized a Patient with Unexpected Pheochromocytoma, Diagnosed during Operation: 1 case report / 대한마취과학회지

Pheochromocytoma is a tumor which secretes catecholamine and produces remarkable hemodynamic changes during the perioperative period. It is reported that in cases where a patient with undiagnosed pheochromocytoma is operated on, the mortality rate can reach 25% to 50%. The subject in this study was a 55-year-old female patient who was diagnosed having a retroperitoneal mass which looked like a neurogenic tumor. During the manipulation, serious hypertension and tachycardia were developed. The authors at that time suspected a pheochromocytoma, interrupted the operation, and after insertion of arterial line and sodium nitroprusside infusion, the rest of the operation was restarted. After the extirpation of the tumor, as the patient suffered serious hypotension, the concentration of the inhalation agent was reduced, ephedrine was injected, the proper amount of fluid and blood were administered, and, as a result, the operation was carried out safely, and postoperative course was unremarkable.