Anaesthetic Management of a Retroperitoneal Paraganglioma: A Case Report

Retroperitoneal tumours, especially paragangliomas, pose peculiar challenges in their surgical and anaesthetic management, as they are hormonally active due to the release of catecholamines. These tumours are typically located adjacent to critical structures, particularly the Inferior Vena Cava (IVC), aorta, and celiac trunk, making their resection hard, due to the risk of haemodynamic instability in the course of surgery. This case report of a 47-year-old male epitomises the importance of a multidisciplinary approach in the management of a retroperitoneal paraganglioma. He had a history of neurogenic bladder and had undergone embolisation of the retroperitoneal mass previously. General Anaesthesia (GA) with thoracic epidural catheterisation was employed as the anaesthetic modality for the surgical removal of the tumour. Invasive monitoring techniques, such as arterial lines and central venous catheters, were used to manage possible surges in catecholamines, haemodynamic shifts, and substantial blood loss during resection of this tumour. The intraoperative hypertensive crisis was managed with nitroglycerine and continuous monitoring and epidural analgesia ensured smooth recovery in the postoperative period. The case points out the necessity of careful preoperative evaluation, advanced intraoperative techniques, and alert postoperative care in handling complex retroperitoneal tumours like paragangliomas.