Preoperative and operative management of patients with phaeochromocytoma.

Abstract

Before the introduction of adrenergic blocking agents and pressor substances operative removal of a phaeochromocytoma was a hazardous procedure, with a mortality of up to 25% (Graham, 1951). A mortality of 50% has been reported in operations on patients with unsuspected turnours (Apgar and Papper, 1951 ; Riddell, Schull, Frist, and Baker, 1963). The dangers were hypertensive crises after induction of anaesthesia, extreme fluctuations of blood pressure during the surgeon's handling of the tumour, sudden hypotension which immediately followed removal of the tumour, arrhythmias from sudden release of large concentrations of sympathomimetic amines, coupled with sensitization of the myocardium to production of arrhythmias by the anaesthetic agent. Complications tended to be more prominent in patients with sustained hypertension.