[Anesthetic management for laparoscopic resection of adrenal pheochromocytoma in a woman with chronic renal failure].

A 52-year-old woman, undergoing hemodialysis for chronic renal failure over thirty years, developed pheochromocytoma. Her serum concentrations of noradrenaline (NA) and adrenaline were 5,330 pg x ml(-1) and 212 pg x ml(-1), respectively. She had often developed hypertensive crisis and also hypotensive crisis during hemodialysis, and quite often she had to give up continuing hemodialysis before its end. Anesthesia was induced by propofol, remifentanil and maintained with oxygen, air, propofol and remifentanil. Before starting operation, continuous hemodiafiltration (CHDF) was performed without any water removal. Although hypotension occurred temporarily after CHDF, severe hemodynamic changes were not observed during operation owing to NA substitution and infusion of 5% plasma protein fraction, and the operation was finished uneventfully. The molecular weight of NA is 169.18, and it can be filtered by CHDF. Because of removal of excessive NA by CHDF, we can avoid severe hemodynamic changes often observed in other case reports. CHDF was useful for anesthetic management of a patient with adrenal pheochromocytoma.