Anesthetic Management of Robotic Adrenalectomy for Pheochromocytoma: A Case Report and Discussion

Abstract

for which an ultrasound and subsequent MRI were performed demonstrating a 4.4 cm right-sided adrenal mass. She demonstrated greater than four metabolic equivalents and denied symptoms associated with increased catecholamines including light headedness, dizziness, vomiting, palpitations, diaphoresis, or flushing. Laboratory analysis found that she had elevated plasma normetanephrine levels at 1903.8 (normal 0-191.8 pg/mL) and normal metanephrine levels at 52.1 (normal range 0-88 pg/mL) leading to the diagnosis of a pheochromocytoma. Past medical history was significant only for hypertension which was treated with lisinopril 10 mg daily. After consultation with urology, our patient decided to proceed with right robotic adrenalectomy. Preoperatively, she was placed on phenoxybenzamine for a total of 17 days prior to surgery for a blood pressure goal of 120/80. After appropriate blood pressure control, she was subsequently placed on metoprolol for a heart rate goal of 60-80 bpm. pulse demonstrated normal sinus The was given 2 of for and a left radial Abstract Pheochromocytomas may secrete a multitude of vasoactive, chronotropic, and inotropic mediators such as norepinephrine and epinephrine. Consequently, these substrates may cause significant hemodynamic variation in the perioperative setting requiring careful preoperative, intraoperative, and postoperative care. In this report, we examine the case of a female patient in her 60s presenting for robotic adrenalectomy for pheochromocytoma. We then review the different stages of management of the patient throughout the perioperative period and the anesthetic and surgical considerations in managing each stage.