Objective: To investigate the clinical features of pheochromocytoma and summarize the experience of anesthetic management during perioperative period.
Methods: Two hundred and fifty eight medical records of patients who were diagnosed as pheochromocytoma in Peking Union Medical College Hospital were reviewed retrospectively for clinical features, anesthetic management and perioperative mortality.
Results: About 5.8% (15/258) of pheochromocytomas was an integral part of multiple endocrine neoplasia (MEN) type II or mixed type. Sixty percent (149/249) of the patients undergoing surgery possessed evidence of catecholamine cardiac toxicity preoperatively, including abnormal ECG, myocardial hypertrophy and decreased left ventricular ejective fraction. Impaired glucose tolerance was found in 59% (147/249) of patients before surgery. The volume infused during operation was significantly higher both in the epidural anesthesia group (3 474 ml +/- 624 ml, q(1) = 5.72, P < 0.01) and in the epidural plus general anesthesia group (3 654 ml +/- 475 ml, q(2) = 5.83, P < 0.01) than that in the general anesthesia group (2 534 ml +/- 512 ml). There were favorable hemodynamic characteristics before removal of the tumor in the epidural anesthesia group and epidural plus general anesthesia group, as compared with in the general anesthesia group. Perioperative mortality was significantly decreased from 8% (5/60) in period 1 (from 1955 to 1975) to 1.2% (1/75) in period 2 (from 1976 to 1994) (chi(2) = 4.05, P < 0.01). No perioperative death (0/111) occurred in period 3 (from 1995 to 2001).
Conclusion: A good surgical outcome for the excision of pheochromocytoma depends on multiple factors, including careful assessment of potential end organ damages and restoration of blood volume by establishing alpha-blockade during the preoperative period, meticulous anesthetic management during surgery, and appropriate circulatory support after surgery.