title: Hypertensive crisis caused by electrocauterization of the adrenal gland during hepatectomy.
abstract: BACKGROUND
  Hypertensive crisis (i.e., systolic blood pressure over 300 mmHg) is very rare during operation except pheochromocytoma, but it can be a fatal and embarrassing to surgeons and anesthesiologists. The right adrenal gland can be electrocauterized during a right hemi-hepatectomy. We report a case of hypertensive crisis during right hemi-hepatectomy in which the right adrenal gland was stimulated by monopolar electrocautery in a patient with normal neuroendocrine function.
  
  
  METHODS
  A 73-year-old man with hepatocellular carcinoma was scheduled to undergo right hemi-hepatectomy. Three hours into the surgery, the patient's blood pressure increased abruptly from 100/40 to over 350/130 mmHg (the maximum measurement pressure of the monitor; 350 mmHg). The surgeon had cauterized the right adrenal gland using monopolar electrocautery to separate the liver from the adrenal gland immediately prior to the event. Approximately 3 minutes after suspending the operation, blood pressure returned to baseline levels. After the event, the operation was successfully completed without any complication. Hormonal studies and iodine-123 meta-iodobenzylguanidine scintigraphy revealed no neuroendocrine tumor such as a pheochromocytoma.
  
  
  CONCLUSIONS
  Operations such as hepatectomy that stimulate the adrenal gland may lead to an unexpected catecholamine surge and result in hypertensive crisis, even if neuroendocrine function of the adrenal gland is normal.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea. ruiwin3518@gmail.com.
authors.forename: A Ram
authors.initials: AR
authors.lastname: Doo
authors.affiliation: Department of Anesthesiology and Pain Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea. sjs6803@jbnu.ac.kr.
authors.forename: Ji-Seon
authors.initials: JS
authors.lastname: Son
authors.affiliation: Department of Anesthesiology and Pain Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea. yjhan@jbnu.ac.kr.
authors.forename: Young-Jin
authors.initials: YJ
authors.lastname: Han
authors.affiliation: Department of Surgery and Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea. hcyu@jbnu.ac.kr.
authors.forename: Hee Chul
authors.initials: HC
authors.lastname: Yu
authors.affiliation: Department of Anesthesiology and Pain Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea. shko@jbnu.ac.kr.
authors.forename: Seonghoon
authors.initials: S
authors.lastname: Ko
mesh_terms: D000311:Adrenal Glands / Q000601:surgery*; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D004564:Electrocoagulation / Q000009:adverse effects*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology*; D007431:Intraoperative Complications / Q000175:diagnosis / Q000209:etiology*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male