Perioperative management of phaeochromocytoma

Phaeochromocytoma is a rare catecholamine producing tumour, feared for its life threatening cardiovascular disturbances during anaesthesia. Improved medical and anesthetic management resulted in reduction of perioperative phaeochromocytoma resection mortality from about 50% in the pioneer period to near 0% nowadays. Cardiomyopathy is usually reversible if managed properly. Stress related or (inverted) Tako Tsubo cardiomyopathy is a recent finding, deserving our attention. Preoperative alpha blockade should be performed to achieve cardiovascular stability and decrease uncontrolled intraoperative surges in blood pressure. During anaesthesia, additional antihypertensive (also mainly alpha blocking) agents are essential to prevent and overcome hypertensive crises. Magnesium sulphate is a safe and promising agent in improving cardiovascular stability and should have a place in standard therapy. A careful selection of anaesthetic drugs and techniques that cause the least hypertension is most important. Preoperative and intraoperative beta-blockade can only be used as adjuvant therapy, mainly to control tachycardia and other rhythm disturbances. Postoperatively, the patient is transferred to the intensive care unit where adequate management of haemodynamic and metabolic complications takes place.