Pheochromocytoma. Tumor localization and surgical management

Recent experience with five cases of pheochromocytoma is the basis for this report. Pharmacological blockade is to be started with phenoxybenzamine before angiographic studies. Arteriography is the preferred localization technique, particularly when combined with bone-subtraction films. Anesthetic management requires special attention to premedication, close monitoring of cardiac rhythm, arterial and central venous pressure, and judicious administration of alpha and beta blockers. Methoxyflurane is no longer the anesthetic agent of choice because of possible nephrotoxicity. Multiple tumors are common. Wide surgical exposure with systematic palpation of autonomic ganglia must be carried out. Manipulation of the tumor does raise arterial blood pressure in spite of adequate preoperative blockade. The alpha blockade prevents the sudden and dangerous vascular collapse which used to be seen after removal of the tumor.