Anaesthesia management of laparoscopic Adrenelectomy: A deluge of differential diagnosis

Abstract

Adrenal tumours are extremely rare tumours and rarely symptomatic. Mostly, it is a post mortem finding. Laparoscopic excision of adrenal tumours is the best approach for tumour excision as it prevents wide abdominal incision maintaining hemodynamic stability, decreasing infection rate, and reducing post-operative ICU stay. Anything that requires adrenal gland manipulation carries the risk of catecholamine release intraoperatively. We report a case of 37 year old female, presenting with complaints of pain in abdomen with abdominal distension. CT scan of abdomen showed well-defined 7.6 *5 *9cm soft tissue lesion arising from left adrenal gland causing indentation on left kidney with well-maintained fat planes between them. Findings were suggestive of left adrenal lipoma. It was important to rule out slightest possibility of secreting adrenergic tumour. All the precautionary measures were taken considering the patient develop hemodynamic instability equivalent to that in pheochromocytoma.We took all the preventive and precautionary measures in anticipation of intraoperative adrenergic crisis as well as maintained hemodynamic stability in laparoscopic surgery. Ruling out possibility of secreting adrenal tumour like pheochromocytoma, cushing syndrome, conn’s syndrome at every step is what our case revolves around. Preoperative hormonal evaluation, smooth and gentle induction of anaesthesia, modern anesthetic drugs, intraoperative hemodynamic stability and strong intraoperative collaboration with surgical team, are the most important steps that can guarantee the successful management of laparoscopic adrenelectomy.