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pheochromocytoma (Anaesthesia (hemodynamic instability - hypo and hyper…
pheochromocytoma
Anaesthesia
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Use of an anaesthetic agent (methoxyflurane or fluroxene) which is not associated with release of endogenous catecholamines
Adequate fluid and blood administration, including preoperative transfusion if necessary.
Careful monitoring during surgery, including direct arterial pressure,
Ready availability of all pharmacological agents appropriate for the control of hypertension, hypotension, and cardiac arrhythmias.
pre anaesthetic work up
phenoxybenzamine
This drug causes a long acting, noncompetitive α-adrenergic blockade; therefore, a surge of catecholamine release cannot override the inhibition as it can with competitive agents
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Pathophysiology
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noradrenaline normally suppresses catecholamine production by a feed back mechanism inhibiting tyrosine hydroxylase - this is not functional in pheochromocytoma's
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two classes of catecholamine receptors Alpha and Beta - physiologic effects are a result of catecholamines on these receptors
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Pheochromocytomas originate from the chromaffin cells of the adrenal gland, which are capable of producing, storing, and secreting catecholamines (e.g., epinephrine, norepinephrine).
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