Anesthetic management for removal of pheochromocytoma in a patient after repair of tetralogy of Fallot

A 45-year-old woman after repair of tetralogy of Fallot at the age of 19, was admitted to the hospital for treatment of paroxysmal hypertension. She was diagnosed with pheochromocytoma of the left adrenal gland, and was scheduled for removal of pheochromocytoma. She received doxazosin for preoperative preparation. Anesthesia was induced with propofol and vecuronium, and maintained with intermittent fentanyl and sevoflurane in nitrous oxide and oxygen. Before induction of anesthesia, magnesium sulfate 40 mg x kg(-1) was injected, and followed by continuous infusion of 40 mg x kg(-1) x hr(-1) until the removal of pheochromocytoma. Under neuromuscular monitoring, vecuronium was administered prudently. Cardiac output was continuously monitored with pulmonary arterial catheter and transesophageal aortic blood flow monitor. Blood pressure and heart rate were stable even though the tumor was handled, and no additional vasodilator therapy was needed. After surgery, prolonged neuromuscular blockade caused by magnesium sulfate was not observed. We consider that successful management was feasible by administration of magnesium sulfate and preoperative administration of alpha1 blocker, under adequate perioperative monitoring.