1/25. Exaggerated cardiovascular response to anaesthesia--a case for investigation.We present a case of a 40-year-old woman who developed major cardiovascular complications during anaesthesia for an elective clipping of a cerebral arteriovenous malformation. Postoperative investigation confirmed the diagnosis of an adrenal phaeochromocytoma. In retrospect, it became apparent that she had experienced a series of potentially life-threatening events over a 20-year period all of which are known complications of phaeochromocytoma. This case highlights the importance of investigating young patients who have unexpected and unexplained cardiovascular events during anaesthesia and surgery.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/25. mydriasis and acute pulmonary oedema complicating laparoscopic removal of phaechromocytoma.This report describes the perioperative management of an adrenergic crisis occurring following insufflation of the peritoneum for planned laparoscopic surgery for phaechromocytoma. Despite preoperative alpha and beta adrenergic blockade, the occurrence of acute severe hypertension, mydriasis and pulmonary oedema prior to direct surgical manipulation caused the procedure to be abandoned. The severity of the event was unusual and most likely contributed to by haemorrhagic necrosis of the tumour releasing catecholamines. serum levels of noradrenaline and adrenaline at the time were 744,600 and 166,940 pg.ml-1 respectively. Treatment included bolus doses of esmolol, nicardipine and urapidil (an alpha 1 adrenergic antagonist) by constant intravenous infusion and mechanical ventilation. Postoperative cerebral CT scan was normal. An abdominal CT showed central haemorrhagic necrosis of the tumour. Two weeks later, open surgical removal of the phaeochromocytoma was successfully performed under general anaesthesia. Induction of pneumoperitoneum for laparoscopy may be particularly hazardous in a patient with a phaeochromocytoma.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
3/25. Use of magnesium sulphate as adjunctive therapy for resection of phaeochromocytoma.The intraoperative control of cardiovascular disturbances associated with the resection of phaeochromocytoma is traditionally achieved by the use of deep anaesthesia in conjunction with alpha and beta blockers, calcium antagonists, nitroglycerine or sodium nitroprusside. We report the successful use of magnesium sulphate as adjunctive therapy in the control of the cardiovascular consequences associated with surgical resection of a phaeochromocytoma in a patient.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
4/25. A case report of the use of magnesium sulphate during anaesthesia in a patient who had adrenalectomy for phaeochromocytoma.INTRODUCTION: patients with phaeochromocytoma have haemodynamic instability during adrenalectomy. CLINICAL PICTURE: A case showing major swings of blood pressure during tumour handling. TREATMENT: magnesium sulphate infusion alone failed to prevent severe hypertension. OUTCOME: The patient had to be given phentolamine and sodium nitroprusside to control the severe hypertension. CONCLUSION: The greatest value of magnesium sulphate is in controlling catecholamine release at induction and intubation, and in association with other agents in controlling arrhythmias and hypertension during tumour handling.- - - - - - - - - - ranking = 0.66666666666667keywords = anaesthesia (Clic here for more details about this article) |
5/25. Phaeochromocytoma: an unusual cause of hypertension in pregnancy.A primiparous, full-term, 28-year-old woman underwent an emergency lower segment Caesarean section under epidural anaesthesia for failure to progress in the first stage. Despite an uneventful pregnancy and delivery, she developed a hypertensive crisis in the postoperative period complicated by acute pulmonary oedema requiring ventilation for 48 h in the intensive care unit. Intravenous magnesium sulphate infusions and hydralazine boluses were used to control the blood pressure, which was associated with clonus, hyperreflexia, tachycardia and profuse sweating. The patient made a good recovery. Later measurement of urinary catecholamines in the recovery phase showed greatly elevated levels of norepinephrine, dopamine and vanillyl mandelic acid. Further investigations included a normal abdominal computed tomography scan and a I-123 meta-iodo-benzyl-guanidine scintigraphy scan which revealed a 3- to 4-cm irregular tumour located at the level of the lower pole of the right kidney and further liver hot spots. Intravenous magnesium sulphate infusion proved successful in controlling hypertension caused by a phaeochromocytoma in the postpartum period.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
6/25. Combined general and epidural anaesthesia for excision of phaeochromocytoma--a unique and safe technique.Surgical excision of phaeochromocytoma is usually associated with elevation of arterial blood pressure above 200 mmHg for some time irrespective of the use or not of preoperative alpha-adrenergic blockade. Attempts at controlling the elevated blood pressure usually involve the use of many drugs through induction, maintenance, termination and post operative period. We recently used a combined general and epidural anaesthesia for excision of a huge phaeochromocytoma in a 24 yr old Nigerian lady with a satisfactory outcome. The combined technique seemed to have modified the anaesthetic course considerably, resulting in the use of fewer drugs and a steady haemodynamic state which is very unusual in anaesthesising patients with phaeochromocytoma (see haemodynamic record Illustration II). Post-operative analgesia was provided with morphine given through the epidural catheter.- - - - - - - - - - ranking = 0.83333333333333keywords = anaesthesia (Clic here for more details about this article) |
7/25. Epidural anaesthesia for insertion of a femoral neck prosthesis in a patient with phaeochromocytoma.A hemiarthroplasty for femoral neck fracture was successfully performed under combined epidural anaesthesia and light general anaesthesia before phaeochromocytoma removal. Pre-operative therapy was managed with doxazosin, enalapril and diltiazem. Peri-operative management facilitated maintenance of stable haemodynamic conditions. Post-operative pain management was provided with continuous 1% lignocaine infusion via an epidural catheter. The phaeochromocytoma was finally removed uneventfully 7 weeks after hemiarthroplasty.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
8/25. Anaesthesia for phaeochromocytoma removal in a 5-year-old boy.We describe the case of a 5-year-old boy with phaeochromocytoma of the left adrenal gland, treated surgically by removal of the tumour under general anaesthesia. Phaeochromocytoma is a particularly rare tumour in children and surgical excision is the definitive treatment. We discuss the clinical and laboratory characteristics of the case, the diagnostic approach, the preoperative and intraoperative management and the postoperative course.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
9/25. Use of a 'hospital-at-home' service for patient optimization before resection of phaeochromocytoma.The perioperative management of phaeochromocytoma remains a complicated anaesthetic challenge, often requiring a prolonged preoperative hospital stay or numerous outpatient clinic visits. This is not only inconvenient for the patient, it also puts them at additional risk of acquiring hospital infections and is expensive to the health service. We present a patient with a phaeochromocytoma who was successfully managed preoperatively with phenoxybenzamine in the community by a 'hospital-at-home' service. She required no other antihypertensives before operation, although glyceryl trinitrate and magnesium sulphate were used before induction of anaesthesia. Apart from intervention for a chest infection on day 3, she had a relatively smooth hospital course and returned home on day 13. We suggest that this may be an appropriate management option for selected patients.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
10/25. enflurane anaesthesia for removal of aldosterone producing adenoma.In a 31-year old woman with a six year history of headache and hypertension a diagnosis of primary aldosteronism was made on the basis of urine samples containing 45 mug/day of aldosterone. The preoperative systemic blood pressure was 240 mm Hg systolic and 120 mm Hg diastolic. The serum potassium level was 2.6 mEq/L and other laboratory findings were within normal limits. The patient was to undergo operation. Pre-medication consisted of oral pentobarbitone, intramuscular pethidine and atropine. For induction of anaesthesia, enflurane 2.0-2.5% maximum was given with O2 (21/min) and N2O (61/min); no intravenous agents were used. Suxamethonium chloride 40 mg was administered to facilitate endotracheal intubation. Anaesthesia was maintained with enflurane 1.5-2.0% with 50% N2O and O2. tubocurarine 27 mg was given for muscle relaxation. When the tumour was manipulated, systemic arterial blood pressure was elevated again to 190 mm Hg systolic and 120 mm Hg diastolic. After removal of the tumour, the arterial pressure and heart rate were stable and recovery from anaesthesia was without circulatory or respiratory complications. plasma aldosterone levels reached a maximum when the tumour was manipulated and fell to normal levels on the second post-operative day. Cortisol levels were not altered markedly even when the tumour was handled. These data imply that adrenocortical response to enflurane anaesthesia as jadged by plasma aldosterone levels would be different from that as estimated by plasma cortisol levels.- - - - - - - - - - ranking = 1.1666666666667keywords = anaesthesia (Clic here for more details about this article) |
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