ABSTRACT
Less than 0.1% of all cases of hypertension are caused by pheochromocytomas. Nevertheless, these tumors are clearly important to the anesthetist because a significant number of hospital deaths in patients with pheochromocytoma occur during the induction of anesthesia for resection or during operative procedures for other causes (1). In a recent case report (2), an undiagnosed pheochromocytoma was considered to be ‘‘the anesthesiologist’s nightmare.’’ The author of an editorial (3) asks the rhetorical question whether pheochromocytoma are specialist cases that all must be prepared to treat. The management of this tumor is analogous to that of malignant hyperthermia, a disease now well understood and manageable with modern protocols. Comparably, the perioperative fatality rate for pheochromocytomas has dropped considerably over the last decades. The increasing use of very sensitive tests for metabolites of circulating catecholamines in combination with genetic screening will bring down the number of unsuspected cases admitted for surgery. Furthermore, improvements in the localization of tumors have accompanied surgical advances. How anesthetic management of patients with pheochromocytomas has advanced over the last four decades is described in several reviews (4-17).
