The perioperative management of a patient with complex single ventricle physiology and pheochromocytoma.
Pheochromocytoma is associated with intense physiologic effects of alpha- and beta-adrenergic stimulation from catecholamine secretion. Perioperative management for these patients includes alpha-adrenergic receptor blockade, intravascular volume replacement, and, if necessary, beta-adrenergic receptor blockade. Significant perioperative changes in preload and afterload, fluid status, heart rate and rhythm, and inotropy can occur and may be contrary to anesthetic management goals for patients with certain conditions of congenital heart disease. We report the perioperative management with doxazosin of a patient with single ventricle physiology and cavo-pulmonary and aorto-pulmonary lung perfusion who presented for resection of a pheochromocytoma.
Sparks
J William
JW
*Division of Perioperative Medicine and †Division of Cardiac Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, and ‡Department of Surgery, Children's Hospital and Harvard Medical School, Boston, Massachusetts.
Seefelder
Christian
C
Shamberger
Robert C
RC
McGowan
Francis X
FX
D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000328:Adult; D000758:Anesthesia; D001794:Blood Pressure / Q000502:physiology; D004310:Double Outlet Right Ventricle / Q000601:surgery*; D017292:Doxazosin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D019990:Perioperative Care; D010673:Pheochromocytoma / Q000601:surgery*
D000317:Adrenergic alpha-Antagonists; D017292:Doxazosin