Abstract
It is well known fact that patients with pheochromocytoma are liable to develop severe circulatory difficulties particularly during operation, because of its excessive secretion of cathecholamine.
The Swan-Ganz catheter was attempted to be used for cardiovascular management in a patient having operative removal of bilateral pheochromocytoma.
The patient was 45-years-old woman with bilateral adrenal pheochromocytoma and cholecystolithiasis. Removal of the tumor with bilateral adrenalectomy and cholecystectomy were undertaken.
Twenty days prior to the operation, oral administration of Prazocin started with an initial dose of 1.5mg increasing up to 3.0mg. The blood volume measured 72.4ml/kg 5 days after the medication. During the medication, increased blood volume was suggested by weight gain and reduction of hematocrit value. Before anaesthesia, a Swan-Ganz catheter was introduced from the right antecubital vein to record pulmonary capillary wedge pressure, cardiac output and systemic vascular resistance.
During removal of the left tumor, the blood pressure rose to 240/150 torr, and sodium nitroprusside infusion started and increased up to 9 μg/kg/min. Although systemic vascular resistance was decreased, the blood pressure remained high and the cardiac index rose to 5.13. The hypertension was considered to be due to hyperdynamic state of the heart, and the blood pressure reduced to 150/100 torr by the administration of Propranolol. After removal of the left tumor, the laboratory data were almost within normal limits as follows; blood pressure of 116/88 torr, heart rate of 90/min, central venous pressure of 15 torn, and pulmorary capillary wedge pressure of 13 torr, except for cardiac index of 1.36 which was markedly depressed. The depression of cardiac index was considered to be due to myocardial depression, and dopamine started at the rate of 3-10μg/kg/min, which normalized cardiac index. Following the operation, the Swan-Ganz catheter was also used for cardiovascular management, and the patient's postoperative course was benign.
We confirmed the usefulness of the Swan-Ganz catheter in close pharmacological control of cardiovascular state particularly during removal of pheochromocytoma
