الفهرس 
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Abstract
Summary
Pheochromocytoma is a catecholamine secreting tumor that arises from the chromaffin cells of the sympathetic nervous system in the adrenal medulla and the sympathetic chain however; it may arise anywhere in the body.
Patients present with a variety of symptoms which reflect excessive secretion of catecholamines (nor epinephrine, epinephrine, or dopamine) into the circulation. The released catecholamines cause significant hypertension, often severe and refractory to conventional treatment.
Early diagnosis and definitive treatment with surgical resection is important because the tumor may be fatal if undiagnosed, especially in patients undergoing surgery for other disorders or in pregnant women during delivery.
Despite recent developments in technology, monitoring and pharmacology, perioperative management of pheochromocytoma remains a highly stressful situation for the anesthesiologists. Appropriate preoperative medical management dramatically decreases morbidity and mortality during the operative management of this tumor.
The preoperative preparation for pheochromocytoma and paraganglioma resection typically includes a titrated alpha adrenergic blockade and an intravascular volume expansion over a period of about two weeks. The hallmark
of perioperative management include a preoperative catecholamine blockade, the intraoperative management of acute catecholamine excess before tumor removal, and an intraoperative intervention for acute catecholamine deficiency after tumor removal.
The perioperative management of pheochromocytomas requires meticulous anesthetic care. Although there has been considerable progress in its management, recent progress has defined 4 agents that may be particularly advantageous to the anesthetic team (magnesium sulphate, vasopressin, clevidipine and methylene blue).