Undiagnosed catecholamine-secreting paraganglioma and coexisting carcinoid in a patient with MH susceptibility: an unusual anesthetic challenge.
The management of a patient with two undiagnosed neuroendocrine tumors and possible malignant hyperthermia (MH) susceptibility poses a unique challenge to the anesthesiologist. We describe a total intravenous anesthetic including an alpha 2-agonist infusion combined with epidurally administered bupivacaine for intra- and postoperative pain management. Alpha 2-agonists may offer improved intraoperative hemodynamic management in patients with catecholamine-secreting tumors and reduce the total dose needed for intravenous anesthetics such as propofol. The latter mechanism may be useful to avert the risk of the propofol infusion syndrome occurring as a consequence of a high cumulative dose following its prolonged administration.
Hudcova
Jana
J
Department of Anesthesia, Tufts-New England Medical Center and Tufts University School of Medicine, Boston, MA, USA.
Schumann
Roman
R
D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage; D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods; D000768:Anesthesia, General / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000008:administration & dosage; D002276:Carcinoid Tumor / Q000150:complications / Q000175:diagnosis*; D002395:Catecholamines / Q000378:metabolism*; D004198:Disease Susceptibility; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008305:Malignant Hyperthermia / Q000517:prevention & control*; D008874:Midazolam / Q000008:administration & dosage; D016343:Monitoring, Intraoperative / Q000379:methods; D018358:Neuroendocrine Tumors / Q000150:complications / Q000175:diagnosis*; D010149:Postoperative Pain / Q000517:prevention & control; D010235:Paraganglioma / Q000150:complications / Q000175:diagnosis*; D010646:Phentolamine / Q000008:administration & dosage; D010656:Phenylephrine / Q000008:administration & dosage; D015742:Propofol / Q000008:administration & dosage; D035583:Rare Diseases
D000316:Adrenergic alpha-Agonists; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D002395:Catecholamines; D010656:Phenylephrine; D008874:Midazolam; D005283:Fentanyl; D002045:Bupivacaine; D015742:Propofol; D010646:Phentolamine