The Anaesthetic Management of a Patient with a Phaeochromocytoma and Acute Stroke

A case is reported of a young woman in whom the diagnosis of a phaeochromocytoma was made after a major stroke. Preoperative preparation included the introduction of phenoxybenzamine, 10 mg.day-1, and propranolol, 80 mg.day-1, over a two-week period. The presence of cerebrovascular disease and the marked orthostatic changes in blood pressure and heart rate to low-dose phenoxybenzamine prevented the establishment of full alpha blockade. Incomplete alpha blockade probably contributed to the hypertensive response to manipulation of the tumour (220/150 mmHg) and hypotension occurred after removal of the tumour (80/45 mmHg). An anaesthetic technique was chosen to provide haemodynamic stability as well as protection against cerebral ischaemia. Invasive haemodynamic monitoring, a four-channel processed electroencephalograph and somatosensory evoked potentials were used to accomplish these goals.