Open AccessANAESTHETIC CHALLENGES & MANAGEMENT OF A PATIENT FOR PHEOCHROMOCYTOMA EXCISION - CASE REPORT
Author(s) -
Ishaan Dubey,
Alpa Nimesh Patel,
Birva Khara
Publication year - 2020
Publication title -
global journal for research analysis
Language(s) - English
DOI - 10.36106/gjra/2400375
Subject(s) - medicine , pheochromocytoma , esmolol , perioperative , anesthesia , adverse effect , blood pressure , hemodynamics , general anaesthetic , intensive care unit , general anaesthesia , catecholamine , surgery , intensive care medicine , heart rate
BACKGROUND: Pheochromocytoma is a rare catecholamine producing tumor of the adrenal gland. Theanaesthetic management of the tumor can be challenging because of hemodynamic uctuationsencountered preoperatively, during induction of anaesthesia, manipulation of tumor & after the excision.OBJECTIVE: To report perioperative anaesthetic management of a 63-year old female with pheochromocytoma for surgicalexcision, the major challenges were uncontrolled hypertension, diabetes with history of ischaemic heart disease.METHOD: Combined general and epidural anaesthesia was used in this patient. Preoperatively, the patient presented withhigh blood pressure which was adequately controlled with alpha and beta blockers. Intra- operatively she developed severehypertension during manipulation of the tumor which was managed pharmacologically with nitroglycerin, esmolol,magnesium sulphate & epidural anaesthesia while hypotension that developed after the excision of the tumor was managedwith intravenous uid, packed cell volume and noradrenaline. Post operatively she was transferred to intensive care unit formonitoring and pain management and she made an uncomplicated recovery.CONCLUSION: Pheochromocytoma is a rare tumor with its management being challenging and patient is at signicant risk formajor adverse cardiac as well as neurological complications. Successful management requires careful preoperativeoptimization, intra operative planning, post operative close supervision and hemodynamic management with thoroughknowledge of the physiology & pharmacology of drugs will lead to good outcome.