[Anesthesia-resuscitation in surgery for pheochromocytoma]

The perioperative mortality related to cardiovascular complications has been almost completely eliminated in phaeochromocytoma surgery. The anaesthetic management has mainly evolved through refinements in haemodynamic control during the operation. Neither preoperative preparation nor general anaesthesia can totally prevent haemodynamic disturbances during surgical manipulation of the tumour or after removal of the tumour. General anaesthesia, with high doses of opioids, remains the most usual technique. Intraoperative monitoring should include an arterial catheter and a pulmonary arterial catheter. Although a number of antihypertensive drugs have been tested, the preventive use of nicardipine i.v. may provide a simple and effective haemodynamic control. Esmolol, an ultrashort acting agent, ensures a dose-related cardiac beta 1-blockade. It is used for the treatment of arrhythmia and cardiac adrenergic stimulation, which causes tachycardia and increases cardiac output. Volume loading is recognised as the treatment of choice for hypotension following tumour removal. During the postoperative period, the great hazard is hypoglycaemia, and plasma glucose levels should be monitored over the immediate postoperative hours.