A descriptive study on the anaesthetic management of patients undergoing surgical removal of phaeochromocytoma. a retrospective review

Abstract

The anaesthetic management of 14 patients undergoing surgical removal of phaeoch romocytoma is described. Hypertension was present in a 11 the pat ients. A 24 hours urine specimen for the determination of vani11ymande1ic acid (VMA) for the presence of phaeochromocytoma was the diagnostic method used in all the patient. The VMA levels were elevated in 10 patients (71.4%). In 57. 1% of the patients , the tumours were located in the adrenal gland. The control of cardiovascular d istu rbahces due to phaeoch romocytoma prior to su rge ry was achieved by alpha and beta adrenergic blocking drugs, phenoxybenzamine and propranolol or oxprenolol respectively. Significant control of blood pressure was observed in 12 patients who where pretreated with both alpha and beta adrenergic blocking agents. The " effect of the pretreatment was analyzed using the paired 't' test. General anaesthesia was administered to all patients undergoing surgical removal of the tumour. Induction of anaesthesia was done with thiopentone, morphine or fentanyl, diazepam and droperido1. combinations. These drugs were used in various Muscle relaxants, tubocu rari ne, pipercuronium, pancuronium, vercuroni um dor suxamethonium were used to facilitate smooth endotracheal intubation. Maintenance of anaesthesia was achieved with halothane in 7 patients, ethrane in

3 patients, neuroleptanalgesia in 4 patients and narcotic analgesics in 2 patients. A marked rise in blood pressure was observed during endotracheal intubation, skin incision and tumour manipulation. were used to .Phentolamine or sodium nitroprusside control the marked rise in blood pressure. The incidence of arrthymias was very low (14.3%) and they were effectively controlled with Lignocaine or propranolol. Fall in blood pressure was noted after complete excision of the tumour. Severe fall in blood pressure occurred in 5 patients. This was corrected by infusing large volumes of intravenous fluids such as normal saline, hartman's solution, 5% dextrose, dextran and blood. Sympathomi met ic agents metaraminol and dopamine were administered to 2 patients in addition to intravenous fluids to correct the hypotension. The cure rate after tumour resection was 64.3%.