Anesthesia Management of Two Operations for Nonfunctional Bladder Paraganglioma

Abstract

Nonfunctional paragangliomas are perioperatively hemodynamically unstable and prone to lethal complications, making anesthesia a high surgical risk. We report the perioperative management of an unanticipated paraganglioma of the bladder over two surgical procedures. The patient developed a hypertensive crisis during the first intraoperative electrodesiccation of the tumor, and the surgeon stopped the operation and sent intraoperative cryopreservation, which was considered a paraganglioma of the bladder. Postoperative histopathological and immunohistochemical results confirmed the case as a paraganglioma of the bladder. Because of the high risk of continuing the surgery, a second surgery was performed after perfecting the preoperative preparation. The patient’s vital signs were stable during the second surgery and the patient’s prognosis was good after the surgery. An unanticipated intraoperative paraganglioma is a major perioperative challenge for anesthesiologists, and the improvement of its outcome is mainly due to good preoperative preparation, intraoperative hemodynamic monitoring, and the application of rapid, potent, and short-acting vasoactive drugs.