Anaesthetic of Mx of cardiac phaeochromocytoma: a case serie
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Primary cardiac phaeochromocytoma is uncommon, with few anaesthetists encountering this rare pathology in clinical practice. Further, there is little information available on the detailed intraoperative and postoperative haemodynamics and principles of the anaesthetic management of this condition.

Published in the International Journal of Surgery Case Reports, the authors present a case series of four patients with cardiac phaeochromocytoma who presented for surgical excision.

Octreotide scintigraphy, in addition to echocardiography, cardiac MRI and coronary angiography proved vital in the preoperative evaluation of these patients. Preoperative anaesthetic management of cardiac phaeochromocytoma involved alpha-adrenergic blockade, judicious beta-adrenergic blockade and hydration.

Intraoperatively, the administration of vasodilatory agents prior to, and vasoconstricting agents with volume therapy after tumour excision, were the key elements of anaesthetic management. Furthermore, the authors believe that cardiopulmonary bypass plays a pertinent role in cardiac phaeochromocytoma excision and that the risks and benefits of pulmonary artery catheters should be considered before use in these patients.

• Primary cardiac phaeochromocytoma is a form of catecholamine-secreting heart tumour. Most anaesthetists never encounter this rare and complex tumour.

• The authors report a single-centre case series of four cardiac phaeochromocytoma surgical excisions.

• Perioperative management included aggressive alpha and cautious beta-adrenergic blockade.

• Intraoperative management requires careful use of vasodilating medications prior to tumour removal and vasoconstrictors with fluids after removal.

• The authors advocate for the use of cardiopulmonary bypass when excising cardiac phaeochromocytoma.

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