title: Perioperative concerns of recurrent urinary bladder phaeochromocytoma with skeletal metastasis.
abstract: We report the perioperative management of a 61-year-old man diagnosed with recurrent urinary bladder phaeochromocytoma with vertebral and rib metastasis following partial cystectomy and nephrectomy. His blood pressure was controlled with antihypertensive agents. Epidural analgesia was avoided in view of vertebral metastasis; instead, analgesia was provided with fentanyl infusion. Intraoperative hypertensive episodes were managed with nitroglycerine, sodium nitroprusside and esmalol. However, after surgery, the patient required inotropic support and was moved to the intensive care unit. Analgesia was maintained with fentanyl infusion, and inotropic support was gradually weaned off. Nuclear ablative therapy was planned for bony metastasis. We recommend that recurrences of extra-adrenal phaeochromocytoma be investigated for bony metastasis and cautiously managed in the perioperative period so as to avoid neurological complications.
authors.affiliation: Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. drrgarg@hotmail.com
authors.forename: V
authors.initials: V
authors.lastname: Darlong
authors.forename: R
authors.initials: R
authors.lastname: Pandey
authors.forename: R
authors.initials: R
authors.lastname: Garg
authors.forename: S
authors.initials: S
authors.lastname: Kumar
authors.forename: J
authors.initials: J
authors.lastname: Punj
mesh_terms: D001859:Bone Neoplasms / Q000556:secondary*; D015653:Cystectomy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D009392:Nephrectomy / Q000379:methods; D059035:Perioperative Period; D010673:Pheochromocytoma / Q000473:pathology / Q000601:surgery*; D012272:Ribs / Q000473:pathology; D013125:Spinal Neoplasms / Q000556:secondary; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*