The anaesthetic management of a patient with a phaeochromocytoma and acute stroke.
A case is reported of a young woman in whom the diagnosis of a phaeochromocytoma was made after a major stroke. Preoperative preparation included the introduction of phenoxybenzamine, 10 mg.day-1, and propranolol, 80 mg.day-1, over a two-week period. The presence of cerebrovascular disease and the marked orthostatic changes in blood pressure and heart rate to low-dose phenoxybenzamine prevented the establishment of full alpha blockade. Incomplete alpha blockade probably contributed to the hypertensive response to manipulation of the tumour (220/150 mmHg) and hypotension occurred after removal of the tumour (80/45 mmHg). An anaesthetic technique was chosen to provide haemodynamic stability as well as protection against cerebral ischaemia. Invasive haemodynamic monitoring, a four-channel processed electroencephalograph and somatosensory evoked potentials were used to accomplish these goals.
Fox
J M
JM
Department of Anaesthesia, University Hospital, London, Ontario, Canada.
Manninen
P H
PH
D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000601:surgery*; D000328:Adult; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D001794:Blood Pressure / Q000502:physiology; D002545:Brain Ischemia / Q000517:prevention & control; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000503:physiopathology; D004569:Electroencephalography; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation; D008991:Monitoring, Physiologic; D010673:Pheochromocytoma / Q000150:complications / Q000601:surgery*; D011229:Preanesthetic Medication