Prevention of hypertensive crisis with ATP during anesthesia for pheochromcytoma

In the anesthetic management of five patients undergoing excision of pheochromocytoma, adenosine triphosphate (ATP) was used for the purpose of regulating systemic arterial pressure during the period of tumor manipulation. ATP was administered at doses of 0.05-0.4 mg/kg/min. Systemic arterial pressure showed a significant decrease from 162 +/- 17/103 +/- 11 mmHg before manipulation to 136 +/- 21/81 +/- 10 mmHg during the manipulation period. The plasma catecholamine levels showed significant increases in this period. Immediately after excision, the systemic arterial pressure was maintained at normal levels (118 +/- 13/75 +/- 16 mmHg) by fluid replacement and discontinuation of ATP administration, subsequently becoming 129 +/- 19/79 +/- 16 mmHg. The heart rate was very stable and tachycardia did not occur during the manipulation period. Only one arrhythmic episode occurred in one patient. The systemic vascular resistance index was significantly lower during the manipulation period than before it. It was therefore considered that ATP was useful as an agent for controlling arterial pressure during the anesthesia for pheochromocytoma.