[Anesthetic management for resection of cardiac pheochromocytoma]

Cardiac pheochromocytoma is a rare disease, and there have been few reports concerning anesthetic management for the resection. This is a report of a 46-year-old man with cardiac pheochromocytoma with the perioperative changes in plasma catecholamine concentrations. Anesthesia was maintained with enflurane (0.5-2.0%) and 50% nitrous oxide in oxygen. Additional fentanyl (900 micrograms) was given as required. Intravenous administration of nitroglycerin in a dose of 5-20 micrograms.kg-1.min-1 was effective for prevention of intraoperative hypertension. After cardiopulmonary bypass and cardioplegic arrest were instituted, the manipulation of the tumor had no effect upon the blood pressure. A serious increase in plasma norepinephrine concentration occurred during both bicaval cannulation and manipulation of the tumor. Although the anesthetic management for resection of adrenal pheochromocytoma has been well-documented, that of cardiac pheochromocytoma requires following specific considerations. 1) Serious hypertension and arrhythmias may occur during manipulation of the heart. 2) It is possible to dissect the tumor safely after isolation of the heart from systemic circulation. It is of great interest that the blood pressure remained almost unchanged during cardiopulmonary bypass despite a marked increase in catecholamine concentrations. 3) Operative mortality rate is high.