Hemodynamic changes during pheochromocytoma laparoscopic resection. Case report

Abstract

Pheocromocytomas are rare malignant tumors which synthesize, store and secrete catecholamines, 85% of them are found in the adrenal. It is often possible to do a curative resection. However, surgical excision of the tumors can be potentially fatal due to acute and severe hemodynamic changes, that could happen during surgery. Laparoscopic surgery is the treatment of choice, because it allows for a less traumatic management of tumor and the better access approach of the adrenal vein, resulting in lower release of catecholamines, that may raise due to the pneumoperitoneum. The anesthetic management in preoperative and perioperative remains a challenge, because these hemodynamic changes differ from one patient to another, regardless of any prior preparation. We report the case of a young patient with tumor in right adrenal with mild clinical conditions upon admitance, not requiring blocking agent in the preoperative. Cardiovascular alterations during pneumoperitonium and tumor management were swiftly controlled by direct arteriolar and venous agent nitruprusside sodium and beta-blocker esmolol. A bibliographic review on different anaesthetic techniques and monitoring is presented.