SummaryA cnse is presented of phaeoc~hromocytomu with cuteuholumine-induced cardiomyopath). The dlfeculties in the rnanugenient when left ventricuiar failure occurred are reported and the importance of nionitoring pulmonary artery pressure during the unaesthetic procedure is strrssed. Key wordsAnue.ctkesia; phaeochromocytoma. C'onipliutions; pulmonary oedema. cardiomyopathy.The anaesthetic management of patients with phaeochromocytoma is notoriously difficult even when the diagnosis has been established prior to surgery. One of the factors causing this difficulty is the presence of cardiom yopathy which, despite being found in 2&309;, of patients with phaeochromocytoma, has received little attention in the literature.'-' Small necrotic foci are found in the myocardium which are apparently unrelated to vascular distribution. There is segmentation of the myocyte cytoplasm within these foci into cosinophilic transverse bands, and interstitial proliferation of mononuclear cells whilst polymorphonuclear cells are unusual. Areas of calcification are found within the fibres. This combination is termed myofibrillar degeneration or myofibrillar damage.4 The myofibrillar damage is due to direct inflammatory cffects of the catecholamines, ischaemia caused by coronary vasoconstriction, relative ischaemia due to increased oxygen demand. and to increased platelet aggregation. ~ -~The clinical manifestations are variable and non-specific, and include disturbances of the cardiac rhythm, congestive heart failure, acute pulmonary oedema coincident with hypertensive crises. and non-specific electrocardiographic changes.6 Case historyThe anaesthetic management and the complications in one patient who presented with phaeochromocytoma and cardiomyopathy are described. The patient was a Caucasian female aged 45 years who had an 1 1-year history of headache. palpitations. hyperhidrosis. pallor and occasional dyspnoea. In the past 3 years she had developed dyspnoea on exertion and had several episodes of pulmonary oedema. She was admitted to hospital with supraventricular tachycardia, left ventricular failure and acute pulmonary oedema which coincided with a hypertensive crisis. This settled a few minutes ~ F

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The cardiovascular effects of equipotent concentrations of enflurane and halothane were studied and compared in two groups of patients. The agents were shown to have similar effects.

Several cases of open‐heart surgery on patients with severe chronic renal failure have been reported in the last few years. The present study reviews the main problems posed by this situation and analyses our recent experience of three successfully managed patients. Emphasis is made on preoperative preparation, drugs employed in anaesthesia, and postoperative management. We conclude that the prognosis of these patients Is good, and that their management is quite similar to that of nephrologically healthy patients.

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