Anesthesia management with short acting agents for bilateral pheochromocytoma removal in a 12-year-old boy

Abstract

A 12-year-old boy with bilateral adrenal pheochromocytoma pretreated with furosemide, nifedipine, prazosin, and propranolol underwent surgical removal of the tumors. General anesthesia with desflurane, remifentanil infusion and thoracic epidural analgesia was performed. To control the blood pressure (BP), remifentanil up to 1 mu g.kg(-1).min(-1) infusion rate, sodium nitroprusside, and esmolol infusions were administered successfully. Following the ligation of the adrenal veins, hemodynamic parameters were stable and neither inotropic support nor corticosteroid replacement was required. We concluded that remifentanil-based anesthesia combined with low-dose desflurane and thoracic epidural analgesia may reduce the need for vasoactive drugs in the anesthesia management of pheochromocytoma. This combination may not prevent the hemodynamic fluctuations during tumor manipulation, but appears to facilitate a rapid and stable postoperative recovery.