Excision of Pheochromocytoma
Clinical Procedure
 
Aliases:
Excision of phaeochromocytoma

Topic aliases are alternate phrasings for a particular topic.


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Ensure preoperative optimisation with alpha then beta blockade, avoid physiological/pharmacological sympathetic stimulation with good analgesia, & treat hypertension early if it occurs.

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Can be associated with multiple endocrine neoplasia 2A
MEN2A refl.in/men2a, or
MEN2B refl.in/men2b

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If intraoperative hypertension occurs, ask surgeon to stop manipulating tumour and administer phentolamine (1-5mg IV) or nitroprusside. refl.in/7w refl.in/7x

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Criteria for optimal preop control: BP consistently <160/90 mmHg; postural hypotension not <80/45 mmHg; no ST-T changes in ECG for 7 days; <1 premature ventricular contraction/5 min. refl.in/8f

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Jun 29, 2011
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Transthoracic echocardiography may reveal hypertensive cardiomyopathy

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If pregnant, resect phaeochromocytoma if diagnosed before midtrimester (<12 weeks) #ref

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Preoperative blood pressure optimisation is essential. Refer for commencement of alpha blockade (@phenoxybenzamine) & once stable, beta blockade if persistent tachycardia

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One large bore intravenous cannula IVC plus central line

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Arterial blood pressure monitoring, inserted pre-induction

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Use non-histamine releasing non-depolarising muscle relaxants to minimise risk of sympathetic surge following hypotension. refl.in/7w

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Supine or lateral position

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Epidural will help with analgesia for open procedures, but won't stop vasoconstriction from circulating catecholamines

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Maintain heart rate <100bpm with esmolol or metoprolol

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Avoid preoperative shivering, consider prewarming

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Check blood glucose. Often hyperglycaemic from catecholamine induced glycogenolysis. #ref

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If undergoing bilateral adrenal excision, will require immediate steroid support

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Monitor blood glucose as this may fall from reduced catecholamine induced glycogenolysis once the tumour is removed

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HDU/ICU for 24hrs of haemodynamic monitoring

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