title: Perioperative management of a child with severe hypertension from a catecholamine secreting neuroblastoma.
abstract: Increased catecholamine secretion from neuroblastomas can occasionally be demonstrated, but severe hypertension is uncommon. We report the perioperative management of a 5 year old child with stage III adrenal neuroblastoma who presented with malignant hypertension and high norepinephrine and dopamine levels. Hypertensive crises occurred during anesthesia for surgical biopsy and during chemotherapy. After blood pressure control using phenoxybenzamine and enalapril, doxazosin was used successfully as the preoperative alpha-adrenergic receptor antagonist for surgical tumor resection.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital, Boston, MA 02115, USA. christian.seefelder@childrens.harvard.edu
authors.forename: Christian
authors.initials: C
authors.lastname: Seefelder
authors.forename: J William
authors.initials: JW
authors.lastname: Sparks
authors.forename: Deborah
authors.initials: D
authors.lastname: Chirnomas
authors.forename: Lisa
authors.initials: L
authors.lastname: Diller
authors.forename: Robert C
authors.initials: RC
authors.lastname: Shamberger
mesh_terms: D000758:Anesthesia; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002395:Catecholamines / Q000378:metabolism* / Q000502:physiology*; D002675:Child, Preschool; D004298:Dopamine / Q000097:blood; D004837:Epinephrine / Q000097:blood; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy*; D007680:Kidney Neoplasms / Q000150:complications* / Q000378:metabolism* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D009447:Neuroblastoma / Q000150:complications* / Q000378:metabolism* / Q000601:surgery; D009638:Norepinephrine / Q000097:blood; D019990:Perioperative Care; D011229:Preanesthetic Medication
chemical_list: D000959:Antihypertensive Agents; D002395:Catecholamines; D004298:Dopamine; D009638:Norepinephrine; D004837:Epinephrine