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Case ReportOpen Access
Anesthesia for One-Stage Bilateral Pheochromocytoma Resection in a Patient with MEN Type Ila : Attenuation of Hypertensive Crisis by Magnesium Sulfate
Nir:1thisard S 
,
Clultrkaw P ,
Laomual S ,
Sunthomyothin S
,
Clultrkaw P ,
Laomual S ,
Sunthomyothin S PHORNLERT CHATRKAW,M.D.*,
SURAT SUNTHORNYOTHIN, M.D.***,
Multiple endocrine neoplasia (MEN) type Ila, manifesting as an autosomal dominant trait,
consists of medullary thyroid carcinoma, parathyroid adenoma or hyperplasia, and pheochromocy-
toma. We report our experience of a 42-year-old woman, MEN type Ila with a large bilateral
pheochromocytoma, who underwent one-stage bilateral tumor resection under a combined conti-
nuous epidural technique with 0.25 per cent bupivacaine and general anesthesia using vecuronium,
fentanyl, nitrous oxide, and isoflurane. An initial intra-operative hypertensive response was accep-
tably controlled by nitroprusside and a
~-blocker
but during tumor handling the hypertensive crisis
worsened and she developed acute pulmonary edema despite a continuing high dose of nitroprus-
side infusion. After receiving intermittent IV MgS0
4
up to 3 g in 15 min, her condition gradually
improved and the cardiovascular response was under control throughout the period of tumor hand-
ling. Hypotension encountered post-pheochromocytoma resection was treated by volume replace-
ment, metaraminol, cacl
2
,
and dopamine infusion. The patient's post-operative course was uneventful.
Key word : Anesthesia, MEN Type Ila, Pheochromocytoma, Acute Pulmonary-Edema, Magne-
sium Sulfate
SURAT SUNTHORNYOTHIN, M.D.***,
Multiple endocrine neoplasia (MEN) type Ila, manifesting as an autosomal dominant trait,
consists of medullary thyroid carcinoma, parathyroid adenoma or hyperplasia, and pheochromocy-
toma. We report our experience of a 42-year-old woman, MEN type Ila with a large bilateral
pheochromocytoma, who underwent one-stage bilateral tumor resection under a combined conti-
nuous epidural technique with 0.25 per cent bupivacaine and general anesthesia using vecuronium,
fentanyl, nitrous oxide, and isoflurane. An initial intra-operative hypertensive response was accep-
tably controlled by nitroprusside and a
~-blocker
but during tumor handling the hypertensive crisis
worsened and she developed acute pulmonary edema despite a continuing high dose of nitroprus-
side infusion. After receiving intermittent IV MgS0
4
up to 3 g in 15 min, her condition gradually
improved and the cardiovascular response was under control throughout the period of tumor hand-
ling. Hypotension encountered post-pheochromocytoma resection was treated by volume replace-
ment, metaraminol, cacl
2
,
and dopamine infusion. The patient's post-operative course was uneventful.
Key word : Anesthesia, MEN Type Ila, Pheochromocytoma, Acute Pulmonary-Edema, Magne-
sium Sulfate
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