Pheochromocytoma - Anaesthetic Management for Laproscopic Excision

in 62 NTG infusion was started with haemodynamic monitoring, oxygen by mask and intravenous fluids.After premedication patient was shifted to the operating room on NTG infusion and oxygen by mask.Arterial and cvp lines were inserted .His BP varied between 250/120 -280/130.The heart rate was normal.Patient was induced with 100microgm of Fentanyl, Midazolam 2mg, .Morphine 9mg, Xylocard 60mg, and Propofol 100mg.Precurarisation was done with Vecuronium, and he was intubated on Succinylcholine 100mgm.NTG infusion, Sevoflurane 1-3%, additional dose of propofol were used to control blood pressure.CVP was maintained at 8-10 cms of H2O.Beta blocker-Esmolol was also used to controll intra op BP.The fall in BP after adrenal vein l i g a t i o n w a s s u p p o r t e d w i t h N o r a d r e n a l i n e i n f u s i o n a n d crystalloids.Duration of surgery was 3 hrs .The patient was ventilated for a day electively on SIMV mode with pressure support.He was extubated the next morning.His BP was120/80, PR-92/mt, regular, CVP-7cms of H2O, FBS-111mgm/dl, Na 139, K 3.8, S.creatine 0.92.No new ECG changes were noted.ABG was normal.His Hb was10.1gms.He was discharged after a week and the biopsy was reported as p h e o c h r o m o c y t o m a .Pheochromocytoma is a tumour of the adrenal medulla.The tumour produces, stores and secretes catecholamines -both epinephrine and nor epinephrine.Incidence of this tumour in hypertensive patients is less than 0.2%.85 to 90% of tumours are solitary.It is also called the 10% tumour.Clinical presentation can be at any age.Tumours are not innervated, So there i s n o n e u r o g e n i c c o n t r o l f o r catecholamine release.Attacks of hypertension may be paroxysmal.Patients may be normal in between (1)