Anaesthetic Challenges in Management of Robotic Bilateral Cortical Sparing Adrenalectomy and Paraganglioma Excision in a Pediatric Patient

Pheochromocytoma accounts for 0.5% to 2% of pediatric hypertension, detected in children between 6 and 14 years of age. As compared to adults, in children it is commonly associated with genetic syndromes or familial diseases such as Neurofibromatosis, Von Hippel Lindau disease and Multiple Endocrine Neoplasia (MEN) type 2A and type 2 B. Diagnosis is by blood biochemistry, CT, Meta- iodobenzylguanadine (MIBG) scan. Complete surgical resection is the definitive treatment. Robotic approach benefits early recovery, minimal tissue handling thereby minimal blood pressure fluctuations. Anaesthetic goal is perioperative blood pressure control, restoration of blood volume, management of arrythmias. Minimally invasive surgery (MIS) does not mean minimally invasive anaesthesia. There are concerns of anaesthesia such as physiological effects of pneumoperitoneum, absorption of carbon dioxide, positioning of patient during surgery, docking and undocking of robotic arms and associated hemodynamic changes. This unique case report aims to describe the clinical presentation, anaesthetic management in a 14-year-old child undergoing robotic bilateral cortical sparing adrenalectomy and paraganglioma excision. We highlight the challenges associated with labile hemodynamics and technical robotic concerns of anaesthesia in pediatric patients. Multidisciplinary approach in tertiary hospital having a Da Vinci Robot, advance monitoring resources and intensive care unit aid in favorable outcome. Genetic screening and counseling facilitate early diagnosis and prevents recurrence.