How is a previously unsuspected and undiagnosed pheochromocytoma managed following induction of anesthesia?
If severe acute hypertension occurs immediately after the administration of one of the so-called trigger drugs or with manipulation of a particular tumor or tissue, the anesthesiologist should maintain a strong suspicion of a pheochromocytoma. If severe sudden hypertension occurs before skin incision, the patient may be best served by canceling the operation and initiating immediate therapy. Later, the appropriate diagnostic tests may be pursued. When intraoperative hypertension occurs from a previously unsuspected pheochromocytoma, it must be treated as discussed previously, avoiding β-blockers as a primary mode of treatment. The patient’s urine should be saved to help in later diagnosis of the disease.
Patients with undiagnosed pheochromocytoma may also present with profound hypotension after induction of anesthesia. This hypotension is due to chronic intravascu-lar depletion and is treated with fluids. Catecholamines administered for treatment may confuse the issue, and should be minimized when there is a suspicion of pheochromocytoma.