Is there any special anaesthetic management for patients with Phaeochromocytoma?
Alpha-blockade and restoration of intravascular volume will substantially reduce perioperative complications.
Treatment of tachycardia and other arrhythmias with b-blockade should only be given after alpha-blockade as it may worsen the hypertension. The management can be divided up into preoperative, intraoperative and postoperative.
Preoperative Management
1) Alpha-blockade (phenoxybenzamine) is given to maintain blood pressure below 180/90mmHg for at least 24hours before surgery.
2) Re-expansion of plasma volume by using intravenous fluids after alpha-blockade.
3) Beta-blockade for treatment of arrhythmias and tachycardias.
4) Metyrosine is given to patients with metastatic disease or patients with severe symptoms. (This drug inhibits catecholamine synthesis).
Intraoperative Management
1) Great caution should be taken when using drugs that may evoke a pressor response. A list of these drugs is shown below:
- Drugs that induce histamine release (e.g. morphine)
- Drugs that interact with catecholamines
- Sympathomimetic agents
- Indirectly acting sympathomimetic agents
2) Haemodynamic management:
- alpha-blockade for immediate treatment of hypertension
- beta-blockade for immediate treatment of arrhythmias
- 2 large-bore iv cannulas should be inserted for rapid iv access.
Postoperative Management
1) Careful blood and fluid management
2) When a bilateral adrenalectomy has been performed, steroid replacement is necessary.