Tcherdakoff P, Terestchenko M C
Ann Med Interne (Paris). 1983;134(3):261-3.
Apart from the problems of preparation for surgery, the difficulties lie mainly in general anaesthesia. Blood pressure variations and cardiac arrhythmias must be prevented. Anaesthesia must be given with a lot of care and must be deep, and some stages are particularly dangerous: induction, intubation (it is best to give a local anaesthetic with lignocaine), manipulation during dissection which should be very gentle, ablation of the tumour or clamping the draining veins. Treatment of the arrhythmias detected on ECG monitoring is based mainly on the use of lignocaine. Continuous monitoring of intra-arterial pressure is used to detect any variation. Only the severe bouts of hypertension need correction with phentolamine or nitroprussiate. In cases of shock, the essential point of management is to reestablish an adequate circulating volume: intravenous fluids are best given with control of pulmonary pressures which allows dangerous overload to be avoided. The specific problem of malignant pheochromocytoma is two-fold: treatment of the hypertension, at best with alpha-methyl-tyrosine or otherwise, with labetolol or prazosine, and treatment of the tumour, which has still not been resolved, and for which trials of chemotherapy are in progress.
