Intraoperative difficulty in cardiorespiratory management during anesthesia for retroperitoneal paraganglioma resection

We report the anesthetic management of a case of paraganglioma, which was challenging because of intraoperative circulatory changes and difficult ventilatory management. A 52-year-old man with a history of chronic obstructive pulmonary disease was scheduled for paraganglioma resection under general anesthesia combined with epidural anesthesia. Since a marked increase in blood pressure was observed immediately after administration of rocuronium, antihypertensive agents were administered as necessary. The ventilatory settings were initially adjusted to deliver a tidal volume of 7 mL/kg, and the drive pressure was maintained at 13 cm H(2)O or less. However, despite increasing the minute volume, PETCO(2) increased to 60 mmHg and PaCO(2) to 76 mmHg before tumor removal. Blood pressure decreased immediately after tumor removal, and PETCO(2) and PaCO(2) gradually returned to normal. We speculated that the increases in PETCO(2) and PaCO(2) might have been due to both an increase in endogenous catecholamine secretion as well as chronic obstructive pulmonary disease. It is important to preoperatively evaluate the functionality of the tumor and to anticipate perioperative cardiorespiratory instability in the management of paragangliomas.