Question

Describe anaesthetic technique for intra-operative management of pheochromocytoma.

Hint:

Maintain alpha and beta blockade throughout the surgery to prevent sudden catecholamine release during tumour manipulation.

Answer 1

Step 1: General Anaesthesia.
General anaesthesia is typically used for pheochromocytoma surgery, with a focus on maintaining stable haemodynamics. The anaesthetist should be prepared for sudden fluctuations in blood pressure, particularly during tumour manipulation.

Step 2: Monitoring Haemodynamics.
Continuous monitoring of blood pressure, heart rate, and ECG is essential. The anaesthetist should be prepared to respond quickly to hypertensive episodes. This includes the use of short-acting antihypertensive medications such as nitroprusside to control sudden surges in blood pressure.

Step 3: Maintaining Alpha and Beta Blockade.
It is important to ensure that the patient remains on adequate alpha and beta blockade throughout the procedure. This prevents the release of catecholamines from the tumour during surgery, which could lead to a hypertensive crisis or arrhythmias.

Step 4: Tumour Manipulation.
During the tumour excision, care must be taken to avoid tumour manipulation before achieving adequate blockade. Sudden release of catecholamines can trigger a hypertensive crisis. The anaesthetist should also be ready to manage potential arrhythmias and sudden drops in blood pressure once the tumour is removed.

Step 5: Conclusion.
Intra-operative management of pheochromocytoma requires careful anaesthesia management to ensure stable haemodynamics, effective blockade, and minimization of catecholamine release. Close monitoring and appropriate pharmacological support are critical during the surgery.