Anaesthetic management of a case of adrenal and extra-adrenal phaeochromocytoma for preoperative embolisation

Jacob, Mathews; Macwana, Saurabh; Vivekanand, D

doi:10.4103/0019-5049.153046

Cited by 1 publication

(1 citation statement)

References 6 publications

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“…1 Conversely, successful embolisation procedures have been described in patients with known phaeochromocytoma for neoadjuvant indications. 2,3 In both cases, the patient was preoperatively managed with alpha blockers, and phentolamine was available.…”

Section: Discussionmentioning

confidence: 99%

Lesson of the month 2: Blunt abdominal trauma: atypical presentation of phaeochromocytoma

et al. 2018

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A 26-year-old man presented following blunt abdominal trauma to a regional major trauma centre for emergency embolisation of a retroperitoneal bleed from a presumed renal laceration. Imaging had also revealed a large right suprarenal mass. Embolisation resulted in a hypertensive crisis raising the suspicion of a metabolically active adrenal tumour. The course was further complicated by the development of ischaemic bowel requiring emergency laparotomy. Intraoperatively he became haemodynamically unstable from an actively haemorrhaging lesion. Emergency laparotomy and adrenalectomy was performed as a life-saving procedure. Histology confirmed a phaeochromocytoma. The patient made a gradual recovery and was discharged home with no sequelae. Definitive management of phaeochromocytoma is surgical resection which requires prolonged preoperative optimisation with alpha receptor blockers to adequately control blood pressure and prevent hypertensive crises. Parenteral alpha receptor blockers, such as phentolamine, are optimal treatment for intraoperative hypertensive emergencies, yet they are currently not available in the UK.

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Section: Discussionmentioning

confidence: 99%