Purpose: To describe the rapid perioperative optimization and control of bl
ood pressure in a young patient who presented with pheochromocytoma. He was
non-compliant with phenoxybenzamine but insisted on early surgery. He was
scheduled for laparoscopic resection of the tumour.
Clinical features: This 32-yr-old man presented with uncontrolled hypertens
ion for a few years for which he was treated with nifedipine. He subsequent
ly defaulted flow-up, The patient presented again approximately three month
s from the day of surgery and was diagnosed to have a pheochromocytoma. The
endocrinologist prescribed phenoxylbenzamine and propanolol in addition to
the nifedipine but the patient stopped taking both drugs six weeks prior t
o surgery due to their side effects. The patient was admitted the evening b
efore surgery to the intensive care unit for rapid control of his blood pre
ssure. Blood pressure was optimized with an infusion of labetolol and volum
e expansion titrated under central venous catheter and intraarterial blood
pressure guidance throughout the night. On the morning of surgery, a magnes
ium sulfate infusion was started. The laparoscopic surgery proceeded uneven
tfully and the patient was hemodynamically stable. There were two transient
periods of hypotension after induction and at removal of tumour respective
ly which were corrected with a brief adrenaline infusion. No adverse outcom
e was noted.
Conclusion: This case highlights the possibility of a more rapid perioperat
ive control of pheochromocytoma using high doses of labetolol and a magnesi
um sulfate infusion to achieve stable intraoperative hemodynamics during la
paroscopic resection of pheochromocytoma.