Introduction: Minimal invasive approaches to pheochromocytoma (PCC) and paraganglioma
(PGL) removal may be complicated by the hemodynamic disturbances that are associated with the
catecholamine secretion from the tumour. The anaesthetic and perioperative monitoring techniques need
to be customized to handle these complications effectively. This retrospective analysis was undertaken to
review the perioperative management of these patients handled by the same anaesthetic and surgical team.
Methods: Case details were collected and data analysed for the perioperative management of 29 patients
who underwent laparoscopic removal of PCC and PGL. Parameters collected included details of preoperative
alpha-and beta blockade, tumour size, number of hypertensive surges, dose of sodium nitroprusside
(SNP) and other vasodilators used and incidence of postoperative hypotension and other complications.
Results: All patients received prazosin for pre-operative optimization. Hypertensive emergencies were
seen in 4 patients during induction and endotracheal intubation and in 1 patient during pneumoperitoneum
insufflation. Overall mean number of hypertensive emergencies was 3.41 (SD-2.45). The patients
undergoing PGL removal had significantly more crisis compared to those undergoing unilateral PCC
removal. The dose of SNP used correlated significantly with tumour size.
Conclusion: Laparoscopic surgery for PCC and PGL removal is associated with hypertensive
emergencies which are amenable to usual doses of antihypertensives used intraoperatively. Surgical
factors like tumour size and location affect the number of crisis and the dose of anti-hypertensives used
more than the anaesthetic drugs and procedures.