Anesthesia management in pheochromacytoma; Our 10 years of experience

Introduction and Purpose: Pheochromocytoma is among the rare neuroendocrine tumors that originating from the neural crest derived from chromaffin cells in the adrenal medulla. Although they are generally benign, they have malignant potential also. Management of pheochromocytoma treatment needs a multidisciplinary approach. In surgery planned patients, it should be aimed to reduce postoperative mortality and morbidity by making an optimal preoperative preparation. In this study, anesthesia management in patients were examined who were operated due to Pheochromocytoma in the General Surgery and Urology operation rooms of Dicle University Hospital between 2010 and 2020. Material Method: In this study, 39 patients were included who were operated due to pheochromocytoma in Dicle University Faculty of Medicine, General Surgery and Urology operation rooms between January 2010 and December 2020. The patients were divided into two groups in the preoperative period, as those who used phenoxybenzamine and doxazosin and who underwent laparoscopy and laparotomy. In addition, in the patients divided into two groups of who cared for catecholamine levels in 24-hour urine and the gender, demographic data, comorbidity and hereditary diseases, tumour localizations, pathological diagnosis, catecholamine levels in 24-hour urine, perioperative management and hemodynamic instability were evaluated. Findings: In our study, 17 (44%) were male, 22 (56%) were female, and the mean age of the patients was recorded as 43.08 (SD: 13.60). Of the 39 masses, 27 were on the right side, 10 on the left side, and 2 patients had bilateral masses. Mean time was recorded as 191 minutes for anaesthesia, 162 minutes for surgery. While MEN 2A was detected in 4 of our patients, MEN 2B was detected in 1 patient and NF-1 was detected in 2 patients. Of the 39 masses which were operated, 7 were malignant and 32 were benign. In patients using doxazosin, both preoperative and intraoperative CAB (Cardiac Apex Beat) were found to be higher (p<0.05). In the laparoscopy group, shorter hospital stay (p<0.05), less need for intensive care (p<0.05), less blood loss (p<0.05) and less blood product use (p<0.05) were recorded. Preoperative systolic blood pressure values of men were higher (p<0.05). In women, intraoperative lowest systole, diastole and mean blood pressure values were recorded to be lower than in male patients (p<0.05). Fifteen (38%) of patients were hemodynamically unstable. Conclusion: It should be kept in mind that excessive release of catecholamines in pheochromocytoma can cause severe and potentially fatal hypertensive crisis. Successful treatment management of pheochromocytoma requires careful preoperative optimization, meticulous intraoperative planning, and hemodynamic management. In the consideration of high risk of complications as described above, all patients should be carefully monitored in the postoperative period. Care should be taken against intraoperative hemodynamic instability (HDI) and necessary precautions should be taken. Key Words: Pheochromocytoma, Alpha receptor blockade, Perioperative management