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CARDIOVASCULAR ANESTHESIA

Perianesthetic Risks and Outcomes of Pheochromocytoma and Paraganglioma Resection

Michelle A. O. Kinney, MD^*, Mary E. Warner, MD^*, Jon A. vanHeerden, MB, FRCS (C), FACS, Terese T. Horlocker, MD^*, William F. Young, Jr., MD, Darrell R. Schroeder, MS^§, Pamela M. Maxson, MS, RN^||, and Mark A. Warner, MD^*

Departments of *Anesthesiology, Surgery, Internal Medicine, and §Health Sciences Research, and the ||Perioperative Outcomes Group, Mayo Foundation, Rochester, Minnesota

Address correspondence and reprint requests to Michelle Kinney, MD, Department of Anesthesiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905. Address e-mail to kinney.michelle{at}mayo.edu

Pheochromocytomas and paragangliomas are often surgically curable. However, resection of these tumors can be life threatening. We undertook this study to determine the frequency of, and risk factors for, perioperative complications in patients undergoing resection of pheochromocytoma or paraganglioma. We retrospectively reviewed the medical records of patients during 1983–1996 who underwent surgical resection of catecholamine-secreting pheochromocytoma or paraganglioma. Preoperative risk factors, adverse intraoperative events, and complications occurring in the 30 days after operation were recorded. Blood pressures were collected from manual records. The ranked sum test and Fisher’s exact test were used for analyses. Adverse perioperative events or complications occurred in 45 of 143 patients (31.5%; exact 95% confidence interval, 24.0% to 39.8%). Of these 45 patients, 41 experienced one or more adverse intraoperative events. The most common adverse event was sustained hypertension (36 patients). There were no perioperative deaths, myocardial infarctions, or cerebrovascular events. Preoperative factors univariately associated with adverse perioperative events included larger tumor size (P = 0.007), prolonged duration of anesthesia (P = 0.015), and increased levels of preoperative urinary catecholamines and catecholamine metabolites: vanillylmandelic acid (P = 0.019), metanephrines (P = 0.004), norepinephrine (P = 0.014), and epinephrine (P = 0.004). Despite premedication of most patients with phenoxybenzamine and a ß-adrenergic blocker, varying degrees of intraoperative hemodynamic lability occurred.

Implications: Few patients who had pheochromocytoma or paraganglioma resection experienced significant perioperative morbidity and none died in the largest retrospective study on this topic to date. This study confirms the very good perioperative outcomes demonstrated in smaller studies on this high-risk population, and identifies several risk factors for adverse outcomes.

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