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Use of nicardipine in the anesthetic management of pheochromocytoma.

For the operative management of pheochromocytoma, phentolamine or sodium nitroprusside have been commonly used for prevention of dangerous hypertension caused by catecholamine release from the tumor. However, these agents exhibit antihypertensive properties by acting on vascular smooth muscle (1,2), not by inhibiting catecholamine release. Recently, the clinical benefits of nifedipine, a calcium slow-channel blocker (i.e., Ca antagonist), have been confirmed in the management of pheochromocytoma symptoms such as acute hypertensive crisis, cardiomyopathy, angina, and palpitation (3,4). Serfas et al. have suggested that the effectiveness of calcium antagonists is related both to its potent vasodilating action and to partial suppression of catecholamine release from pheochromocytoma (4). We report a case of pheochromocytoma successfully managed intraoperatively with an infusion of nicardipine, a new short-acting calcium antagonist for intravenous use, in a patient in whom sublingual administration of nifedipine had been effective for relief of the preoperative symptoms.