The successful anesthetic management of a patient with pheochromocytoma using prostaglandin E₁ and a novel, short-acting β-adrenergic blocker: Landiolol hydrochloride

A 48-year-old male with a history of hypertension was scheduled to undergo resection of a tumor in the upper region of the left kidney. However, his operation was postponed once because pheochromocytoma was suspected from the tumor location, sweating, and insomnia in addition to hypertension. The measurement of plasma catecholamines confirmed the presence of pheochromocytoma. Anesthesia was induced with thiopental and fentanyl, while ventilating with 5% sevoflurane in oxygen, followed by tracheal intubation facilitated with vecuronium. Anesthesia was maintained with 33% nitrous oxide and 0.6-3% sevoflurane in oxygen, in conjunction with fentanyl and 1% mepivacaine through an epidural catheter (T11-12). An arterial catheter and a pulmonary artery catheter were inserted. From the beginning of the operation, prostaglandin E₁ and landiolol were administered continuously. Systolic blood pressure and heart rate were controlled between 90-140 mmHg and 80-105 beats · min^-1, respectively. Systemic vascular resistance was stable between 700-900 dyn · s · cm^-5 throughout the procedure. The operation was completed uneventfully. The patient was transferred to the general ward, extubated, and was in a stable condition. Various combinations of vasodilating and anti-hypertensive drugs have been used intraoperatively during the resection of pheochromocytoma. Of these, prostaglandin E₁ and landiolol hydrochloride are very promising for maintaining stable hemodynamics.