title: Anesthesia for one-stage bilateral pheochromocytoma resection in a patient with MEN type IIa: attenuation of hypertensive crisis by magnesium sulfate.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Supranee
authors.initials: S
authors.lastname: Niruthisard
authors.forename: Phornlert
authors.initials: P
authors.lastname: Chatrkaw
authors.forename: Samrit
authors.initials: S
authors.lastname: Laornual
authors.forename: Surat
authors.initials: S
authors.lastname: Sunthornyothin
authors.forename: Sutthisinee
authors.initials: S
authors.lastname: Prasertsri
mesh_terms: 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
chemical_list: D008278:Magnesium Sulfate; D002045:Bupivacaine