Abstract
Tumours secreting catecholamine are a known perioperative anaesthetic challenge. However, extra adrenal location of such tumors can cause sudden catastrophe in unprepared patients. A 45 year old, 50 kg female patient scheduled for transurethral cystoscopic resection of bladder tumour of suspected neoplastic aetiology, developed sudden, severe tachycardia, hypertension, and arrhythmias followed by hypotension under general anaesthesia. Tumour biopsy obtained during first surgery confirmed diagnosis of Paraganglioma (PGL). This was supported with normal vanillyl mandelic acid (VMA), 6.5mg/24hrs (normal 2-8mg/24hrs) and a large polypoidal mass on CT in a patient with episodic symptoms of headache and blackout associated with micturition; a classical triad reported about this tumour category. Findings of MIBG (Meta iodo benzyl guanidine) 131I scan that reported no MIBG avid disease, were equivocal. Accurate diagnosis, good perioperative control of blood pressure and volume status using invasive monitoring and cascade of drugs to manipulate circulation when required, formed the essence of successful management of the patient during her second surgery.
Highlights
Pheochromocytoma (PCC) is a tumour arising from chromaffin cells of adrenal medulla and secreting one or more catecholamines, adrenaline, noradrenaline and dopamine
*Correspondence: VN Gadre E mail: vaijayantigadre@hotmail.com Received: 09/01/2017 Accepted: 17/04/2017 DOI: 10.4038 /slja.v25i2.8203. It was an unprepared case and the patient went into ventricular tachycardia and life threatening severe hypertension, arrhythmias and hypotension while under general anaesthesia for the biopsy
The management of patients with PCC and PGL remains a challenge for anaesthesia
Summary
Pheochromocytoma (PCC) is a tumour arising from chromaffin cells of adrenal medulla and secreting one or more catecholamines, adrenaline, noradrenaline and dopamine. PGLs produce paroxysmal symptoms.[1] We present a case of cystoscopic biopsy and later excision of bladder tumour, not suspected to be a PGL before surgical biopsy. Case report A 45yr old 50kg female with complaints of burning micturition, two episodes of haematuria associated with sweating, headache and black out since last six months, was scheduled for cystoscopy and biopsy As soon as manipulation was stopped, ECG showed sinus rhythm and the systolic BP became 50mmHg. BP was restored with intravenous fluids, procedure was abandoned after biopsy and patient was shifted to ICU for monitoring. There were no signs of somnolence; intermittent epidural doses of 4ml of 0.25% bupivacaine were well tolerated and blood sugar values recorded ranged between 70-85mg%
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