Keyword
Pheochromocytoma
Definition
Catecholamine-secreting tumor that consists of cells originating from the embryonic neural crest
Rule of 10
- 10 % are extra-adrenal
- 10% are malignant
- 10% are familial
- 10% are bilateral
- 10% are found in children
- 10% are not associated with hypertension
Treatment
- Preoperative assessment : α-adrenergic blockade(phenoxybenzamine) & volume replacement,
- add β-blocker (need to control HR, reduce arrhythmias) (항상 α-blocker->β-blocker 순서로)
- Intraoperative hypertension : phentolamine, nitroprusside, nicardipine, clevidipine,
- ABP monitoring, Deep anesthesia intubation, cardiac disease 동반 시 C-line, TEE (필요시)
- tumor venous ligation 후 hypotension from hypovolemia : "fluid resuscitation" & infusion of α-agonist (phenylephrine or norepinephrine)
Best avoided !!(하면안됨)
ephedrine, hypoventilation, large bolus doses of ketamine, Halothane (arrhythmic effects), large doses of atracurium or morphine sulfate
Reference
Morgan & Mikhail's Clinical Anesthesiology, 5th edition, Ch.34, P.740-741