Anesthetic management of pheochromocytoma and paraganglioma for patients with Fontan circulation: a case series

Yuto Tanaka; Makoto Sumie; Takuma Hashimoto; Sayaka Osawa; Yuji Karashima; Tadashi Kandabashi; Ken Yamaura

doi:10.1186/s40981-023-00605-z

Anesthetic management of pheochromocytoma and paraganglioma for patients with Fontan circulation: a case series

JA Clin Rep. 2023 Mar 10;9(1):13. doi: 10.1186/s40981-023-00605-z.

Authors

Yuto Tanaka^{1

2}, Makoto Sumie^{3

4}, Takuma Hashimoto¹, Sayaka Osawa⁵, Yuji Karashima⁶, Tadashi Kandabashi⁷, Ken Yamaura¹

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
² Department of Anesthesia, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan.
³ Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan. sumimako348@gmail.com.
⁴ Department of Anesthesia, St. Mary's Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan. sumimako348@gmail.com.
⁵ Department of Critical Care, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
⁶ Operating Rooms, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
⁷ Medical Information Center, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.

Abstract

Background: Anesthetic management of pheochromocytoma and paraganglioma with Fontan circulation is challenging for physicians, with attention to cardiovascular physiology.

Case presentation: We performed anesthetic management for pheochromocytoma and paraganglioma in three patients with Fontan circulation. We maintained intraoperative central venous pressure at preoperative level under fluid infusion and administrating nitric oxide to decrease pulmonary arterial resistance. We administered noradrenaline or vasopressin if low blood pressure was present despite adequate central venous pressure. Although noradrenaline is prevalent for the case of noradrenaline-secreting tumor especially after resection, we could maintain blood pressure to administrate vasopressin without increasing central venous pressure. Retroperitoneal laparoscopic approach which could avoid intra-abdominal adhesions might be selectable as case 3.

Conclusions: Sophisticated management is required for pheochromocytoma and paraganglioma with Fontan circulation.

Keywords: Fontan circulation; Paraganglioma; Pheochromocytoma; Retroperitoneal laparoscopic; Vasopressin.