Anesthesia for laparoscopic adrenalectomy (pheochromocytoma) in an anemic adult Jehovah's Witness

Purpose: To report the anesthetic management of an anemic Jehovah's Witness patient presenting for laparoscopic adrenalectomy for pheochromocytoma. Clinical Features: A 49-yr-old woman presented with hemodynamic instability progressing to cardiogenic shock and subsequent acute renal failure. Her c ourse was complicated by anemia. An adrenal pheochromocytoma was diagnosed. Preoperatively, alpha- and beta-adrenergic blockade was instituted with ph enoxybenzamine and metoprolol therapy and her anemia was treated with eryth ropoietin. She underwent laparoscopic resection of the adrenal tumour. A ce ll saver device was employed and attached to the laparoscopic suction-irrig ation apparatus to provide salvage capability in the event of a major hemor rhage. The surgical intervention was uneventful and well tolerated. The pat ient was discharged home and well on follow-up. Conclusions: Cell salvage is the only mechanism currently acceptable to Jeh ovah's Witnesses which will allow for perioperative salvage and replacement of blood loss. Its use is encouraged in all situations in which surgical h emorrhage is anticipated.