Challenging anesthesia in pediatric pheochromocytoma and paraganglioma tumors resection

Abstract

Pheochromocytoma (PCC) and paraganglioma (PGL) are chromaffin cell tumors that secrete catecholamines and are some of the rarest pediatric tumors. Perioperative care poses a challenge for the anesthetist. Hemodynamic regulation, surgery manipulation, and perioperative care require special attention. These tumors provide major treatment challenges as well as a high risk of hypertensive crisis-related cardiovascular consequences. We present a successfully managed case of PCC removal in a 13-year-old male. He presented with typical hypertensive crisis symptoms (i.e., vomiting, headaches, and seizures), and he was managed well to prepare him for surgery. We anticipated hemodynamic alterations during the surgery and controlled them with a combination of antihypertension, vasodilator, and epidural analgesia. The safe perioperative care of such patients requires good communication between an experienced multidisciplinary team of surgeons, pediatric endocrinologists, and anesthetists.