MetroHealthAnesthesiaAnesthesia and Pheochromocytoma

Clinical Manifestations
  • catecholamine-secreting tumor
  • cells from embryonic neural crest (chromaffin tissue)
  • 1 of 1,000 hypertension patients
  • most unilateral and benign
  • 10-15% malignant
  • 10-15% bilateral or extra-adrenal
  • Signs
    • paroxysmal headache
    • hypertension
    • sweating
    • palpitations
  • rarely presents with unexpected intraoprative hypertension and tachycardia
Anesthetic Considerations
  • Preoperative considerations
    • evaluate
      • arterial blood pressure
      • orthostatic blood pressure and heart rate changes
      • evidence of myocardial ischemia
    • adrenergic blockade
      1. alpha blockade
        • phenoxybenzamine
        • helps correct
          • volume deficit
          • hypertension
          • hyperglycema
      2. consider additional beta blockade after alpha blockade if
        • no cardiomyopathy (check ECHO)
        • persistent tachycardia
        • persistent dysrhythmia
    • volume replacement
      • chronic hypovolemia
      • decrease in RBC mass and plasma volume
      • aided by alpha-adrenergic blockade
      • may unmask underlying anemia
  • Operating room considerations
    • arterial line
    • good IV access
    • monitor urinary output
    • central venous pressure (CVP) monitoring
    • maybe pulmonary artery catheter (e.g. evidence of catecholamine cardiomyopathy)
    • intubate deep
    • treat intraop hypertension
      • phentolamine
        • specific adrenergic blocker
      • nitroprusside
        • rapid onset
        • short duration of action
        • familiarity
      • nicardipine
    • best avoid
      • sypathetic nervous system stimulants
      • potentiating catecholamine dysrhythmias due to
      • inhibit parasympathetic nervous system
        • pancuronium
      • histamine release caused by
        • atracurium
        • morhpine sulphate
    • after tumor resection
      • hypotension
        • hypovolemia
        • persistent adrenergic blockade
        • abrupt drop in circulating catecholamine level
      • fluid resuscitation based on
        • arterial blood pressure
        • urinary output
        • CVP
        • pulmonary capillary occlusion pressure
        • surgical bleeding
        • third-space losses
      • adrenergic agent infusion occasionally necessary
        • phenylephrine
        • norepinephrine
  • Postoperative
    • hypertension may indicate
      • occult tumor(s) or
      • volume overload




Greg Gordon MD
Updated: