Anesthesia for one-stage bilateral pheochromocytoma resection in a patient with MEN type IIa: attenuation of hypertensive crisis by magnesium sulfate.
Multiple endocrine neoplasia (MEN) type IIa, manifesting as an autosomal dominant trait, consists of medullary thyroid carcinoma, parathyroid adenoma or hyperplasia, and pheochromocytoma. We report our experience of a 42-year-old woman, MEN type IIa with a large bilateral pheochromocytoma, who underwent one-stage bilateral tumor resection under a combined continuous epidural technique with 0.25 per cent bupivacaine and general anesthesia using vecuronium, fentanyl, nitrous oxide, and isoflurane. An initial intra-operative hypertensive response was acceptably controlled by nitroprusside and a beta-blocker but during tumor handling the hypertensive crisis worsened and she developed acute pulmonary edema despite a continuing high dose of nitroprusside infusion. After receiving intermittent i.v. MgSO4 up to 3 g in 15 min, her condition gradually improved and the cardiovascular response was under control throughout the period of tumor handling. Hypotension encountered post-pheochromocytoma resection was treated by volume replacement, metaraminol, CaCl2, and dopamine infusion. The patient's post-operative course was uneventful.
Niruthisard
Supranee
S
Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Chatrkaw
Phornlert
P
Laornual
Samrit
S
Sunthornyothin
Surat
S
Prasertsri
Sutthisinee
S
D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods; D000328:Adult; D000758:Anesthesia / Q000379:methods*; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D007431:Intraoperative Complications / Q000175:diagnosis / Q000188:drug therapy*; D008278:Magnesium Sulfate / Q000008:administration & dosage*; D018813:Multiple Endocrine Neoplasia Type 2a / Q000150:complications / Q000175:diagnosis; D010673:Pheochromocytoma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome
D008278:Magnesium Sulfate; D002045:Bupivacaine