ANAESTHETIC MANAGEMENT OF GIANT PHAEOCHROMOCYTOMA IN A PATIENT WITH CHRONIC RENAL DISEASE
Badmus TA†
Sanusi AA‡
*Department of Anaesthesia, †Department of Surgery, and ‡Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
E-mail address: tonieadenekan@yahoo.com
*Correspondence
Grant support: None
Conflict of Interest: None
ABSTRACT
Background: Phaeochromocytoma is a rare catecholamine secreting tumour characterized by increase in systemic vascular resistance and blood pressure. It account for 0.1% of hypertension in the general population. Early diagnosis and definitive treatment with surgical excision is generally advocated as complications of undiagnosed phaeochromocytoma may be fatal, especially in patients undergoing surgery for other disorders or in pregnant women during delivery. The diagnosis of phaeochromocytoma often requires detailed preparations because of the challenges its excision poses to the anaesthetist, the surgeons and other members of the management team especially where the incidence is low and experience in the management suboptimal.
Results: This report illustrates the perioperative management of a 29year old female who presented with severe hypertension complicated by chronic kidney disease and a huge left adrenal mass confirmed to be phaeochromocytoma. After preoperative optimization, the left adrenal tumour weighing 1,350g was successfully excised under general anaesthesia. Severe hypertensive crisis during surgery was successfully controlled with a combination of phentolamine, glycerine trinitrate and magnesium sulphate, while hypotension following removal of the tumour was managed with graded dosages of dopamine. Postoperative recovery was uneventful and she was discharged home in satisfactory condition seven days after surgery.
Conclusion: Perioperative management of patients with phaeochromocytoma though challenging, can be successfully undertaken with adequate preoperative optimization, use of appropriate drugs and adequate perioperative monitoring.
Key words: Anaesthesia, Phaeochromocytoma, Chronic renal disease, Catecholamine surge, Hypertensive crisis.