Anaesthetic management of phaeochromocytoma of lesser sac in a patient with rheumatic heart disease using combined general and epidural anaesthesia

Phaeochromocytoma is a rare catecholamine-secreting neuroendocrine tumour, accounting for less than 0.1% of hypertensive population with a high cardiovascular morbidity and mortality if left untreated. Extra-adrenal phaeochromocytomas of lesser sac are still rarer. Due to its rarity, anaesthetic experience is also limited. Surgical resection is the only curative therapy. During surgery there is a high risk of massive release of catecholamines, which can result in potentially fatal hypertensive crisis and cardiac arrhythmias. The perioperative management of phaeochromocytoma remains a challenge for the anaesthesiologist, despite the advent of new drugs and techniques, requiring intensive preoperative preparation and vigilant intraoperative and postoperative care. This case report describes the perioperative anaesthetic management in a 38year old female patient with phaeochromocytoma of lesser sac with Rheumatic heart disease. We used combined general and epidural anaesthesia for tumour removal surgery, resulting in the use of fewer drugs and a smoother perioperative anaesthetic course and post-operative analgesia was provided with morphine supplemented through the epidural catheter. This case report highlights the importance of epidural blockade for excision of phaeochromocytoma, especially in a developing country, where the latest techniques and advanced monitoring facilities are unavailable and affordability is a major issue. Key Words: Epidural; General Anaesthesia; Phaeochromocytoma of lesser sac; Mitral Regurgitation DOI: 10.4038/slja.v18i2.1639 Sri Lankan Journal of Anaesthesiology 18(2): 87-90 (2010)