Anesthetic Management for Giant Abdominal Paraganglioma Resection in a Patient After Extracorporeal Membrane Oxygenation: A Case Report

Paraganglioma (PGL) is a rare neuroendocrine tumor that poses significant challenges to anesthetic management during surgical resection. In rare instances, PGL can precipitate a catecholamine crisis, potentially leading to heart failure, intracranial hemorrhage, renal failure, arrhythmias, pulmonary edema, and multisystem organ failure. We report a case of a 53-year-old male with a history of poorly controlled hypertension who was admitted for chest pain and initially diagnosed with non-ST-elevation myocardial infarction (NSTEMI). Coronary angiography revealed no abnormalities. Subsequently, the patient experienced cardiac arrest. Despite aggressive resuscitation, persistent hypoxemia necessitated extracorporeal membrane oxygenation (ECMO) support. Abdominal CT revealed a large retroperitoneal mass suggestive of PGL. Following active resuscitation, the patient was successfully weaned from ECMO. After thorough preoperative optimization and multidisciplinary collaborative surgery with precise anesthetic management, the tumor was successfully resected. This case demonstrates that for patients with PGL experiencing heart failure secondary to catecholamine crisis, tumor resection under general anesthesia can be safely performed after thorough preoperative preparation. Furthermore, this rare case highlights the need for clinicians to consider the possibility of a PGL-induced catecholamine crisis in patients admitted with chest pain, acute myocardial infarction, or acute heart failure.