Perianesthetic risks and outcomes of pheochromocytoma and paraganglioma resection

Pheochromocytomas and paragangliomas are often surgically curable. However, resection of these tumors can be life threatening. We undertook this study to determine the frequency of, and risk factors for, perioperative complic ations in patients undergoing resection of pheochromocytoma or paragangliom a. We retrospectively reviewed the medical records of patients during 1983- 1996 who underwent surgical resection of catecholamine-secreting pheochromo cytoma or paraganglioma. Preoperative risk factors, adverse intraoperative events, and complications occurring in the 30 days after operation were rec orded. Blood pressures were collected from manual records. The ranked sum t est and Fisher's exact test were used for analyses. Adverse perioperative e vents or complications occurred in 45 of 143 patients (31.5%; exact 95% con fidence interval, 24.0% to 39.8%). Of these 45 patients, 41 experienced one or more adverse intraoperative events., The most common adverse event was sustained hypertension (36 patients). There were no perioperative deaths, m yocardial infarctions, or cerebrovascular events. Preoperative factors univ ariately associated with adverse perioperative events included larger tumor size (P = 0.007), prolonged duration of anesthesia (P = 0.015), and increa sed levels of preoperative urinary catecholamines and catecholamine metabol ites: vanillylmandelic acid (P = 0.019), metanephrines (P = 0.004), norepin ephrine (P = 0.014), and epinephrine (P = 0.004). Despite premedication of most patients with phenoxybenzamine and a p-adrenergic blocker, varying deg rees of intraoperative hemodynamic lability occurred.