Sevoflurane with continuous epidural anesthesia for removal of pheochromocytoma

A 66-year-old female was scheduled for right adrenalectomy because of a pheochromocytoma. Preoperative blood pressure was well controlled with an alpha.beta blocker, amosulalol hydrochloride 40 mg per day po for 2 weeks. The patient received midazolam 2.5 mg im and scopolamine 0.4 mg im 60 minutes before induction. Anesthesia was induced with midazolam 5 mg iv, fentanyl 0.1 mg iv and vecuronium 12 mg iv, and maintained with continuous epidural infusion of 1.5% lidocaine, and inhalation of 66% nitrous oxide in oxygen and sevoflurane (0.5-3%). Blood pressure was controlled with nicardipine (1-6 micrograms.kg-1.min-1) before removal of the pheochromocytoma. After removal of the tumor blood pressure was maintained with intravenous infusion of lactated Ringer's solution, dopamine (3-8 micrograms.kg-1.min-1), dobutamine (3-8 micrograms.kg-1.min-1) and norepinephrine (0.1-0.2 micrograms.kg-1.min-1). A combination of continuous epidural block and sevoflurane anesthesia was very useful for removal of the pheochromocytoma. Swan-Ganz catheter monitoring was also very useful before and during operation to determine the optimal doses of nicardipine, catecholamine and the volume of transfusion.