Unresponsive asystolic cardiac arrest responding to external cardiac pacing in a patient with phaeochromocytoma.
An anaesthetised 48-year-old woman became haemodynamically unstable following biopsy of a thoracic mass suggesting a diagnosis of a thoracic phaeochromocytoma. Surgery was postponed to allow confirmatory investigations and pre-operative adrenoceptor blockade with phenoxybenzamine and labetalol. Nine days later, following resection of her phaeochromocytoma, she suffered an intra-operative asystolic cardiac arrest which was unresponsive to standard resuscitation protocols and required external cardiac pacing. We discuss the issues involved and suggest that the competitive alpha(1) adrenoceptor antagonist doxazosin may be preferable to the covalently bound mixed alpha adrenoceptor antagonist phenoxybenzamine in the pre-operative preparation of patients with phaeochromocytoma.
Taylor
M J
MJ
Department of Anaesthesia, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK. drmjtaylor@yahoo.co.uk
McIndoe
A
A
D000310:Adrenal Gland Neoplasms / Q000150:complications* / Q000601:surgery; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017292:Doxazosin / Q000627:therapeutic use; D005260:Female; D006323:Heart Arrest / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007431:Intraoperative Complications; D008875:Middle Aged; D010643:Phenoxybenzamine / Q000627:therapeutic use; D010673:Pheochromocytoma / Q000150:complications* / Q000601:surgery; D011229:Preanesthetic Medication
D000317:Adrenergic alpha-Antagonists; D010643:Phenoxybenzamine; D017292:Doxazosin