title: Torsades de pointes during laparoscopic adrenalectomy of a pheochromocytoma: a case report.
abstract: BACKGROUND
  Torsades de pointes is a rare but potentially lethal arrhythmia. The amount of literature available on Torsades de pointes occurring in patients with pheochromocytoma is limited, and we found no literature describing this dysrhythmia in a patient with pheochromocytoma under anesthesia.
  
  
  METHODS
  We describe the case of a 42-year-old Caucasian woman without QT prolongation preoperatively with recurrent Torsades de pointes during laparoscopic removal of a pheochromocytoma. Torsades de pointes mainly occurs in the setting of a prolonged QT interval. This patient neither had a prolonged QT preoperatively nor was her family history suspect for a congenital long QT syndrome. Most likely, our patient had an acquired long QT syndrome, elicited by the combination of flecainide, hypomagnesemia and adrenergic stimulation during manipulation of the tumor.
  
  
  CONCLUSIONS
  We show that in the case of a surgical pheochromocytoma removal, perioperative conditions can elicit an acquired or previously unknown congenital long QT syndrome. Therefore, preoperative α- and β-blockade is advised, QT-prolonging drugs should be avoided and potassium and magnesium plasma levels should be kept at normal to high levels.
authors.affiliation: Department of Anaesthesiology, University Medical Centre Groningen, PO Box 30,001, 9700 RB Groningen, The Netherlands. H.G.D.Hendriks@umcg.nl.
authors.forename: Kinge
authors.initials: K
authors.lastname: van der Heide
authors.forename: Ann
authors.initials: A
authors.lastname: de Haes
authors.forename: Götz Jk
authors.initials: GJ
authors.lastname: Wietasch
authors.forename: Ans Cp
authors.initials: AC
authors.lastname: Wiesfeld
authors.forename: Herman Gd
authors.initials: HG
authors.lastname: Hendriks