[Plasma catecholamine levels in patients during surgical removal of pheochromocytoma under sevoflurane anesthesia].

Abstract

We measured plasma catecholamine levels and hemodynamics in 5 patients during surgical removal of pheochromocytoma under sevoflurane anesthesia. Plasma catecholamine levels were unchanged with sevoflurane anesthesia. Plasma epinephrine, norepinephrine and dopamine levels increased 149 folds, 7.8 folds and 2.9 folds respectively as compared with preanesthetic values during surgical manipulation of the tumor, and then declined in magnitude but still remained 15 folds, 2.7 folds and 1.8 folds higher respectively as compared with the preanesthetic levels after removal of the tumor. These catecholamine levels finally reached 180%, 20% and 60% of the preanesthetic values respectively after the emergence from anesthesia in the recovery room. Mean systolic and diastolic arterial blood pressures were 127/82 mmHg before anesthetic induction and increased to 211/71 mmHg during manipulation of the tumor. Then they decreased to 75/52 mmHg immediately after removal of the tumor but recovered up to 126/71 mmHg on recovery from anesthesia. Alpha and beta adrenal blockers were administered if necessary to control hypertension and tachycardia during manipulation of the tumor. Hypotension after removal of the tumor was treated with volume replacement, vasopressor and/or catecholamines. No correlation was found between plasma catecholamine levels and arterial blood pressure in our study except during manipulation of the tumor. No arrhythmias were observed during anesthesia and surgery in our cases even though plasma catecholamines increased extremely with surgical intervention. We conclude that sevoflurane anesthesia is a better choice for surgery for pheochromocytoma.