Abstract :
Pheochromocytoma is a rare tumor of adrenal gland, treatable, curable cause of hypertension and may lead to premature death if not treated early. Medical management by multidisciplinary team is essential for hemodynamic stability during the perioperative period. General anaesthesia with thoracic epidural block offers adequate stress control as hemodynamic fluctuations are quite common and significant during induction, peritoneal insufflation and tumor manipulation. Newer modalities of diagnosis, short acting drugs to control hypertension, vigilant anaesthetic management with beat to beat monitoring of hemodynamics significantly improves patient’s safety. Laparoscopic mobilisation of the adrenal helps in minimal manipulation of the tumour and thus minimising the resultant catecholamine surge. However, hypotension upon ligation of adrenal vein is inevitable. Noradrenaline (NA) remains the vasopressor of choice which has to be continued post operatively. A thorough pre-anaesthetic evaluation, preparation and execution with a multimodal analgesic pain management in a high dependency unit aid in early ambulation and discharge of the patient.
Keyword :
Adrenal tumour, Catecholamine, Laparoscopy, Multiple Endocrine Neoplasia.