title: Pheochromocytoma - when acute medicine comes to the surgeon's rescue and vice versa. Case report of a patient presenting unmanageable haemodynamic instability during elective surgery for pheochromocytoma.
abstract: We report and discuss the case of a 51-year-old patient undergoing elective laparoscopic surgery for pheochromocytoma after 10 days of medical pre-treatment. After anaesthetic induction, a deep level of anaesthesia could not prevent the onset of repeated hypertensive peaks, followed by severe hypotensive periods. Once the surgical incision was made, the patient developed acute pulmonary oedema along with significant oxygen desaturation. The decision was made to stop the surgery and transfer the patient to the intensive care unit (ICU) for further support and management. Unfortunately, additional monitoring and symptomatic treatment did not help haemodynamic stabilisation. In the absence of any external stimulation or medical support, the oscillation of blood pressure (BP) continued with peaks every 20 minutes up to 300 mmHg systolic blood pressure (SBP) and falls down to 30 mmHg SBP. The patient also sustained two episodes of cardiac arrest from which he recovered. Facing this unmanageable situation, a decision was made after a multi-disciplinary discussion to go back to surgery in order to remove the source of adrenergic stimulation. Surgery by laparotomy was performed and catecholamine substitution was provided. Nevertheless, after tumour removal, BP dropped leading to a third cardiac arrest that was successfully managed. Following a 10-day stay in the ICU, the patient left with subsequent cardiac stabilisation and full recovery.
authors.affiliation: a Department of Anesthesiology , Université catholique de Louvain, Cliniques universitaires Saint-Luc , Brussels , Belgium.
authors.forename: Lien
authors.initials: L
authors.lastname: Jakus
authors.affiliation: b Department of Intensive Care , Université catholique de Louvain, Cliniques universitaires Saint-Luc , Brussels , Belgium.
authors.forename: Luc-Marie
authors.initials: LM
authors.lastname: Jacquet
authors.affiliation: c Department of Endocrinology , Université catholique de Louvain, Cliniques universitaires Saint-Luc , Brussels , Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Maiter
authors.affiliation: d Surgery and Abdominal Transplantation Division, Department of Surgery , Université catholique de Louvain, Cliniques universitaires Saint-Luc , Brussels , Belgium.
authors.forename: Michel
authors.initials: M
authors.lastname: Mourad
authors.affiliation: c Department of Endocrinology , Université catholique de Louvain, Cliniques universitaires Saint-Luc , Brussels , Belgium.
authors.forename: Corinne
authors.initials: C
authors.lastname: Jonas
authors.affiliation: a Department of Anesthesiology , Université catholique de Louvain, Cliniques universitaires Saint-Luc , Brussels , Belgium.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Scholtes
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000503:physiopathology / Q000601:surgery; D002395:Catecholamines / Q000097:blood; D002637:Chest Pain; D006261:Headache; D006323:Heart Arrest; D006801:Humans; D006973:Hypertension; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000503:physiopathology / Q000601:surgery
chemical_list: D002395:Catecholamines
keywords: Anaesthesiology; Endocrinology; Intensive care; Pheochromocytoma; Surgery