Perioperative anesthetic management in suprarenal pheochromocytoma tumor resection

Pheochromocytoma is a neuroendocrine tumor that is a malignant degeneration of chromaffin cells in the medulla of the suprarenal gland. Until recently, the mainstay treatment for pheochromocytoma is surgery. A 48 years-old male patient was referred with a diagnosis of left suprarenal tumor. Alpha blockers, specific beta-1 blockers, and calcium channel blockers are recommended for pheochromocytoma. The patient was given doxazosin 1x1mg, amlodipine 1x10 mg and bisoprolol 1x5 mg. Pheochromocytoma surgery can be performed by laparoscopy or by laparotomy. Abdominal CT scan showed a mass in the left suprarenal area with a size of 43 x 54.1 x 46.7 mm and a laparoscopic adrenalectomy was scheduled. Induction agents frequently used are propofol and etomidate. Induction in this case were using fentanyl, propofol, and rocuronium. Maintenance anesthesia used O2 40%, sevoflurane 1-2 vol%, dexmedetomidine, fentanyl, and rocuronium. After surgery, the patient was admitted in the ICU with relatively stable blood pressure. The patient was given FFP and PRC transfusion due to severe anemia which subsequently showed improvement on the second day. All agents that cause histamine release and sympathetic stimulation should be avoided as much as possible. The recurrence rate for pheochromocytoma is 14% in the primary location or 30% in the extra-adrenal. Therefore, its long-term follow-up is necessary. If there is persistent hypertension for a long period after surgery, suspicion of residual pheochromocytoma tissue should be considered. In this case the blood pressure was 95-110/62-73 mmHg on the first day and 91-113/67-70 mmHg on the second day.