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Canadian Journal of Anesthesia 49:682-686 (2002)
© Canadian Anesthesiologists' Society, 2002
General Anesthesia

Variable hemodynamic fluctuations during resection of multicentric extraadrenal pheochromocytomas

[Fluctuations hémodynamiques variables pendant la résection de phéochromocytomes extrasurrénaliens multicentriques]

Anis Baraka, MD FRCA, Sahar Siddik-Sayyid, MD FRCA, Maya Jalbout, MD and Chadi Yaacoub, MD

From the Department of Anesthesiology, American University of Beirut-Medical Center, Beirut, Lebanon.

Address correspondence to: Dr. Anis Baraka, Professor and Chairman, American University of Beirut, Department of Anesthesiology, P.O. Box 11 0236, Beirut, Lebanon. Phone: 961 1 350000; Fax: 961 1 744464; E-mail: abaraka{at}aub.edu.lb

Purpose: To report the perioperative management and the serious hemodynamic fluctuations during manipulation of an organ of Zuckerkandl tumour in a patient undergoing resection of multicentric extraadrenal pheochromocytomas.

Clinical findings: A 28-yr-old man who had undergone at age 12 a laparotomy for excision of an extraadrenal pheochromocytoma complained of paroxysmal headache, occasional sweating and palpitations. The arterial blood pressure (BP) was 200/100 mmHg. A 24-hr-urine collection showed catecholamines 5076 µg•24 hr-1 (normal < 25 µg•24 hr-1). Computed tomography of the abdomen revealed two retroperitoneal masses, one adjacent to the lower pole of the right kidney and a second larger mass located at the aortic bifurcation in the region of the organ of Zuckerkandl. The patient was scheduled for excision of multiple extraadrenal pheochromocytomas. He was prepared preoperatively for two weeks with prazosin 1 mg po q six hours and propranolol 10 mg tid. Manipulation of the infrarenal tumour was uneventful but manipulation of the Zuckerkandl tumour resulted in severe hypertensive episodes with BP ranging from 200/100 to 320/120 mmHg. Surgery was interrupted temporarily; the hypertensive crisis was controlled by the infusion of sodium nitroprusside and by iv phentolamine and esmolol.

Conclusion: In a patient undergoing resection of recurrent multicentric extraadrenal pheochromoctyomas, severe hypertensive episodes occurred during manipulation of one tumour but not during manipulation of the other. This may be attributed to inadequate preparation of the patient, difficult surgical dissection of the large Zuckerkandl pheochromocytoma, and/or secondary to an excessive and different pattern of release of catecholamines during manipulation of the Zuckerkandl tumour.




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