Unexplained hypertension during induction of a patient with phaeochromocytoma.
An unexplained hypertensive response during the induction of anaesthesia for phaeochromocytoma resection is described. This response was not accompanied by elevations in plasma catecholamine levels. It occurred despite heavy premedication and followed induction with etomidate, alfentanil, lignocaine, vecuronium and magnesium sulphate (MgSO4). A bolus of esmolol (0.5 mg/kg) lowered the blood pressure rapidly. Subsequent haemodynamic manipulations were carried out by varying the rate of an esmolol infusion. A constant background infusion of MgSO4 was maintained throughout the procedure. These produced satisfactory haemodynamic control despite marked rises in plasma catecholamine levels.
Department of Anaesthesia, Hillbrow Hospital, Johannesburg.
A G
AG
Beeton
E A
EA
Shipton
B J
BJ
Katz
D000310:Adrenal Gland Neoplasms / Q000601:surgery; D000328:Adult; D015760:Alfentanil / Q000009:adverse effects; D000768:Anesthesia, General / Q000009:adverse effects*; D005045:Etomidate / Q000009:adverse effects; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000628:therapy; D007828:Laryngoscopy; D008012:Lidocaine / Q000009:adverse effects; D010673:Pheochromocytoma / Q000601:surgery; D014673:Vecuronium Bromide / Q000009:adverse effects
D015760:Alfentanil; D014673:Vecuronium Bromide; D008012:Lidocaine; D005045:Etomidate