Perioperative management of a child with severe hypertension from a catecholamine secreting neuroblastoma.
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.
Seefelder
Christian
C
Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital, Boston, MA 02115, USA. christian.seefelder@childrens.harvard.edu
Sparks
J William
JW
Chirnomas
Deborah
D
Diller
Lisa
L
Shamberger
Robert C
RC
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
D000959:Antihypertensive Agents; D002395:Catecholamines; D004298:Dopamine; D009638:Norepinephrine; D004837:Epinephrine