Can a patient be successfully prepared for pheochromocytoma surgery in three days? A case report.
The case of a patient who insisted on urgent surgical removal of a pheochromocytoma is presented. Rapid preparation started with continuous infusion of urapidil 3 days before surgery. On the evening before the operation, an additional infusion of magnesium sulphate was started. The target of preoperative optimization was to maintain blood pressure <140/90 mm Hg and heart rate <100 beats min(-l). Anesthesia was induced with fentanyl, propofol and rocuronium and maintained with sevoflurane in 100% oxygen and continuous infusion of fentanyl. Hypertensive events were treated by continuous infusions of urapidil and magnesium sulphate. Just before tumor resection, additional boluses of urapidil and MgSO4 were administered; both fentanyl infusion and end tidal concentration of sevoflurane were increased. Blood pressure was well maintained through the anesthesia; no transient periods of hypotension after tumor removal were observed. The patient's peroperative course was uneventful. He was discharged home without antihypertensive medication on the 5th postoperative day. This case demonstrates that with urapidil and magnesium sulphate administration rapid preparation for pheochromocytoma resection can be successfully achieved within 3 days.
Jankovic
R J
RJ
Department of Anesthesia and Intensive Care, University Clinical Center, Nish, Serbia and Montenegro.
Konstantinovic
S M
SM
Milic
D J
DJ
Mihailovic
D S
DS
Stosic
B S
BS
D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D002395:Catecholamines / Q000652:urine; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008278:Magnesium Sulfate / Q000627:therapeutic use; D008297:Male; D010673:Pheochromocytoma / Q000601:surgery*; D010879:Piperazines / Q000627:therapeutic use; D011300:Preoperative Care
D000317:Adrenergic alpha-Antagonists; D002395:Catecholamines; D010879:Piperazines; D008278:Magnesium Sulfate; C015568:urapidil