Perioperative Preparation, Anesthetic and Surgical Approach to Children with Wilms Tumor, Pheochromocytoma, and Paraganglioma

Wilms tumor is the most common renal malignancy in children. Most children present with an asymptomatic abdominal mass, abdominal pain, anorexia, or hematuria. Anesthetic challenges are associated with blood loss, IVC compression, and ventilation from increased intra-abdominal pressures. Acquired von Willebrand disease and effects of chemotherapy can be added challenges. Pheochromocytomas are rare tumors, with less than 5% of cases reported in children. Presentation varies depending on symptoms from catecholamine secretion (i.e., hypertension) and mass effect from the tumor. Intraoperatively, increased catecholamines may cause vasoconstriction, severe hypertension, and dysrhythmias. After tumor removal, the decrease in catecholamines may lead to profound hypotension. For both tumors, pain management should be multimodal with regional or neuraxial anesthesia when possible.