크롬친화세포종 수술의 마취 관리

Abstract

Normotensive pheochromocytoma as incidentaloma detected during the surgery is a challenge for the anesthesiologists, despite the advent of new drugs. A 53-year-old female patient was referred for removal of a deep mesenteric mass suspected mucinous cyctic tumor. She was in normal range of blood pressure and on medications for hyperthyroidism. There was a surge of systolic blood pressure when the tumor was manipulated in the operation field, and extreme fluctuations in blood pressure prevented the continuous infusion of intravenous antihypertensive drugs. After ligation of the draining vein, decreased blood pressure needed vasopressors. Pathologic examination of the tissue confirmed the presence of pheochromocytoma. Preoperative management using α-adrenergic blockade is helpful for abating hypertensive crisis during the surgery. When pheochromocytoma is suspected due to sudden surge of blood pressure during the surgery, prompt and proper choices in the management of blood pressure and volume status should be conducted and surgical method of ligating draining vein may be needed.