Anesthetic management by combined spinal and epidural anesthesia for a case of ectopic bladder pheochromocytoma

Abstract

Background: We report a safe anesthetic management of a patient with preoperatively diagnosed ectopic pheochromocytoma who underwent bladder tumor resection with combined spinal subarachnoid anesthesia and epidural anesthesia (CSEA). Case presentation: The patient was an 85-year-old male, 152 cm in height and weighing 65 kg. The patient was admitted to our hospital with a complaint of anemia. Ectopic pheochromocytoma was suspected because of the different shape of the tumor and increased rerum noradrenaline. Due to complications of interstitial pneumonia, we planned to perform CSEA for this case. When surgical manipulation was applied to the bladder, a sudden increase in blood pressure above systolic pressure of 200mmHg was observed, and nicardipine 1 mg was administered. Afterwards, the surgery was completed without any major circulatory changes and postoperative course was uneventful. Conclusion: In patients with appropriate preoperative diagnosis and blood pressure control, spinal anesthesia or CSEA may be an alternative for ectopic pheochromocytoma in the bladder.