Anesthesia for One-Stage Bilateral Pheochromocytoma
Resection in a Patient with MEN Type Ila : Attenuation
of Hypertensive Crisis by Magnesium Sulfate
SUPRANEE NIRUTHISARD, M.D.*, PHORNLERT CHATRKAW,M.D.*,
SAMRIT LAORNUAL, M.D.**, SURAT SUNTHORNYOTHIN, M.D.***,
SUTTHISINEE PRASERTSRI, M.D.*
Affiliation : *Department of Anesthesiology,
** Department of Surgery,
***Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
AbstractMultiple endocrine neoplasia (MEN) type Ila, manifesting as an autosomal dominant trait,
consists of medullary thyroid carcinoma, parathyroid adenoma or hyperplasia, and pheochromocy
toma. We report our experience of a 42-year-old woman, MEN type Ila with a large bilateral
pheochromocytoma, who underwent one-stage bilateral tumor resection under a combined conti
nuous epidural technique with 0.25 per cent bupivacaine and general anesthesia using vecuronium,
fentanyl, nitrous oxide, and isoflurane. An initial intra-operative hypertensive response was accep
tably controlled by nitroprusside and a ~-blocker but during tumor handling the hypertensive crisis
worsened and she developed acute pulmonary edema despite a continuing high dose of nitroprus
side infusion. After receiving intermittent IV MgS0 up to 3 g in 15 min, her condition gradually
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improved and the cardiovascular response was under control throughout the period of tumor hand
ling. Hypotension encountered post-pheochromocytoma resection was treated by volume replace
ment, metaraminol, cacl , and dopamine infusion. The patient's post-operative course was uneventful.
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Keywords : Anesthesia, MEN Type Ila, Pheochromocytoma, Acute Pulmonary-Edema, Magne
sium Sulfate
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