[Anesthetic management for laparoscopic pheochromocytoma resection in a patient with cardiac dysfunction under dynamic monitoring].

A 51-year-old women with cardiac dysfunction due to catecholamine-induced cardiomyopathy underwent laparoscopic adrenalectomy for pheochromocytoma. Her preoperative cardiac status was New York Heart Association (NYHA) class IIand left ventricular ejection fraction (LVEF) was 45%. In her anesthetic management, we used FloTrac® system and monitored arterial pressure-based cardiac output (APCO) and stroke volume variation (SVV) continuously as the indicator of intraoperative hemodynamics. Although her hemodynamics fluctuated highly during manipulation of the tumor and after ligation of adrenal vein intraoperatively, we could manage them rapidly by adjusting administration of vasodilator or pressor agents and appropriate volume expansion under monitoring APCO and SVV. The operation was completed successfully and postoperative course was almost uneventful. As laparoscopic pheochromocytoma resection is accomplished in a brief period with less surgical invasion compared with laparotomy, it may be possible to manage hemodynamics of the patient with cardiac dysfunction properly under dynamic monitoring using FloTrac® system.