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Management of life‐threatening hypertension in a 12‐year‐old bichon frise undergoing an adrenalectomy for phaeochromocytoma excision
Author(s) -
Ferreira Jacques Paul,
Raszplewicz Joanna
Publication year - 2017
Publication title -
veterinary record case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.165
H-Index - 4
ISSN - 2052-6121
DOI - 10.1136/vetreccr-2016-000365
Subject(s) - medicine , anesthesia , acepromazine , esmolol , isoflurane , fentanyl , blood pressure , propofol , capnography , hydromorphone , surgery , opioid , heart rate , receptor
A bichon frise, previously diagnosed with a phaeochromocytoma, underwent phenoxybenzamine treatment 17 days before adrenalectomy. Preoperative haematology, biochemistry and oscillometric blood pressure readings for the 12 year old were typical. Before anaesthesia, methadone and medetomidine were administered intramuscularly. Anaesthesia was induced using propofol titrated to permit endotracheal intubation and maintenance of anaesthesia using an isoflurane in oxygen mixture. Invasive blood pressure monitoring by a cannula in a dorsal pedal artery promptly revealed life‐threatening hypertension. Rapid increase in isoflurane concentration, multiple intravenous fentanyl boluses administration and commencement of an esmolol citrate infusion were unsuccessful in attenuating the hypertension observed. Rapid rises in end‐tidal carbon dioxide and resultant tachypnoea necessitated atracurium intravenously and positive pressure ventilation. Hypertension was eventually abolished using intravenous acepromazine, which ultimately caused a hypotensive nadir. Reduction in anaesthetic depth and aggressive fluid therapy resolved hypotension before termination of anaesthesia. Management of hypertension in dogs with phaeochromocytoma remains challenging.