To summarize the key points of anesthesia management and identify the prognostic factors in patients undergoing retroperitoneal paraganglioma resection.

A retrospective analysis was performed on patients undergoing retroperitoneal paraganglioma resection with general anesthesia from January 2016 to December 2021 at Peking University International Hosptial. Data on anesthesia management, haemodynamic changes, blood loss, and blood transfusion were collected, and potential prognostic factors were identified.

A total of 41 patients who received retroperitoneal paraganglioma resection were included in this study, including 28 males and 13 females with a mean age of (51.3±11.8) years. Following the American Society of Anesthesiologists (ASA) criteria, 7 patients were classified as having ASA I, 25 as having ASA Ⅱ, and 9 as having ASA Ⅲ. During surgery, 14 patients (34.2%) developed a hypertensive crisis, and 9 (46.3%) developed hypotension after tumor removal. There were 15 cases receiving phenoxybenzamine as preoperative treatment started (16.2±7.0) days on average before surgery, of whom 5 (33.3%) developed a hypertensive crisis during retroperitoneal paraganglioma resection and 9 developed hypotension after tumor removal.Of the remaining 26 cases with no phenoxybenzamine pre-treatment, 9 developed a hypertensive crisis and 10 developed hypotension after tumor removal. Among the 41 cases included, plasma catecholamine concentrations were measured in 27 patients before surgery. Of these individuals, 17 showed an increase in noradrenaline (12 of the 17 patients received phenoxybenzamine as preoperative treatment), 4 showed an increase in adrenaline, and 7 showed an increase in dopamine. The median (range) volume of haemorrhage was 1039.5 (50~4500) ml among all the subjects, of whom 7 (16.3% of total) had intraoperative hemorrhage greater than 2000 ml. Regarding perioperative blood product use, 20 cases received packed RBC transfusions, 19 received plasma transfusion intraoperatively, 13 were treated with 20% albumin infusions, 7 were treated with fibrinogen supplementation, and 7 received prothrombin complex concentrate intraoperatively. Mean duration of operation was (3.4±1.5) h, and mean duration of anaesthesia was (4.6±1.5) h. Thirty-seven patients were extubated in the operating room at the end of the surgery, and four were transferred to the intensive care unit. There were no perioperative deaths and no in-hospital deaths in this series. All patients were discharged uneventfully. The average length of stay in the hospital after operation was (16.5±8.8) days, which was negatively correlated with the systolic blood pressure after tumor removal, but had no significant correlation with emergent hypertensive crisis episodes during surgery (P＞0.05).

Retroperitoneal paraganglioma resection is associated with a high risk of major bleeding and dramatic hemodynamic fluctuation. Proper preoperative evaluation and preparation in combination with appropriate anesthetic management are of vital importance to patient safety in the preoperative stage.