Dexmedetomidine in anaesthesia for a high-risk case of pheochromocytoma with poor left ventricular function

Hegde, Harihar V; Maheshwari, Shivi; Pai, B. Srinivas; Ahmed, Sameer

doi:10.4103/0019-5049.176281

Cited by 4 publications

(5 citation statements)

References 5 publications

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“…In a patient, 1 μg/kg dexmedetomidine IV resulted in a 49.42% decrease in blood norepinephrine levels ( Singh and Singh, 2014 ). Several case reports in human medicine have consistently described a possible advantage of using dexmedetomidine and overall conclude that it does not totally prevent hemodynamic fluctuations during mass manipulation, but it contributes greatly to intraoperative hemodynamic stability, reducing hypertensive episodes ( Wong and Cheung, 2004 ; Bryskin and Weldon, 2010 ; Schumann and Hudcova, 2010 ; Jung et al ., 2012 ; Khetarpal et al ., 2014 ; Ali Erdogan et al ., 2015 ; Dias et al ., 2015 ; Hedge et al ., 2016 ; Shrestha et al ., 2016 ; Giordano et al ., 2019 ; ). In the veterinary literature, a decrease in vascular resistance following a dexmedetomidine infusion has not been reported.…”

Section: Discussionmentioning

confidence: 99%

“…Its sympatholytic properties ( Gertler et al ., 2001 ) render this agent attractive for the anesthetic management of phaeochromocytoma resection. While its use as an intraoperative constant rate infusion (CRI) has been described in humans ( Wong and Cheung, 2004 ; Bryskin and Weldon, 2010 ; Schumann and Hudcova, 2010 ; Jung et al ., 2012 ; Khetarpal et al ., 2014 ; Ali Erdogan et al ., 2015 ; Dias et al ., 2015 ; Hedge et al ., 2016 ; Shrestha et al ., 2016 ; Giordano et al ., 2019 ; ), concomitant vasodilators were still frequently needed during surgical manipulation. There is, to date, a single case report of its perioperative use for phaeochromocytoma removal in a canine patient ( Viilmann and Vettorato, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

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Anaesthetic management of a dog undergoing unilateral adrenalectomy for phaeochromocytoma excision using a partial intravenous anaesthetic protocol

Gavet,

Junot

2024

Open Vet J

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Background: The anaesthetic management of adrenalectomies for phaeochromocytoma excision, a catecholamine secreting tumour, is challenging due to the potential for fatal complications following severe haemodynamic variations, including hypertensive crisis following tumour manipulation or sympathetic stimulation, but also severe hypotension and volume depletion post resection. Case Description: An 11kg, 15-year-old male neutered Jack Russel Terrier, with mitral valve disease (MVD) stage B2, was referred for adrenalectomy for phaeochromocytoma resection. The patient was administered per os prazosin 0.11mg/kg twice a day and amlodipine 0.125mg/kg once a day for preoperative stabilisation. On the day of surgery, the dog received maropitant 1mg/kg intravenously (IV) and was premedicated with 0.2mg/kg methadone IV. Anaesthesia was induced with alfaxalone 1mg/kg IV and midazolam 0.2mg/kg IV and maintained with a partial intravenous anaesthesia using sevoflurane in 70% oxygen and constant rate infusions of dexmedetomidine 0.5μg/kg/h and maropitant 100μg/kg/h. After induction of anaesthesia, the dog was mechanically ventilated, and a transversus abdominal plane block was performed with ropivacaine 0.2%. The dog remained remarkably stable with a single, self-limiting, hypertension episode recorded intraoperatively. Postoperative rescue analgesia consisted in methadone and ketamine. The dog was discharged 48h after surgery, but persistent hypertension was reported at suture removal. Conclusion: The use of a low dose dexmedetomidine CRI, a maropitant CRI and a TAP block provided stable perioperative haemodynamic conditions for phaeochromocytoma excision in a dog.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anaesthetic management of a dog undergoing unilateral adrenalectomy for phaeochromocytoma excision using a partial intravenous anaesthetic protocol

Gavet,

Junot

2024

Open Vet J

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“…Dexmedetomidine, an α-2 receptor agonist, has been described in human medicine in combination with other drugs (e.g., MgSO 4 ) to achieve haemodynamic stability during phaeochromocytoma resection ( 1 , 28 – 30 ). The activation of α-2 receptors leads to a dose-dependent reduction in plasma catecholamines since they take part in the regulation of noradrenaline release through a negative feedback mechanism ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic Management of a Labrador Retriever Undergoing Adrenalectomy for Phaeochromocytoma Excision, a Case Report

et al. 2022

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Perioperative management of cases undergoing phaeochromocytoma removal should aim at normalising blood pressure and heart rate, restoring volume depletion, and preventing catecholamine release induced by surgical manipulation. In this case report, a novel pharmacological approach in a dog undergoing surgical tumour excision is described. A 7-year-old 25-kg spayed female Labrador Retriever presented for repeated episodes of generalised weakness, pale mucous membranes, tachycardia, tremor, panting, vomiting, and hypertension over the last month was referred for surgical treatment of a left-sided adrenal tumour with invasion of the caudal vena cava. Severe hypertensive episodes occurred repeatedly, starting early during the anaesthetic period, while clipping and cleaning the abdominal area, and continued intraoperatively when the tumour was handled. Moderate hypotension occurred once the tumour was isolated and worsened during temporary caudal vena cava flow interruption and cavotomy. The patient was treated preoperatively with phenoxybenzamine to prevent hypertensive crises. Intraoperatively, magnesium sulphate and urapidil were used to control blood pressure. This treatment was effective in reducing the magnitude of blood pressure spikes but not sufficient to prevent hypertensive peaks, especially during tumour manipulation. Hypotension was treated with synthetic colloid and crystalloid boli, and noradrenaline continuous infusion. Blood transfusion was performed in response to acute bleeding during cavotomy. The dog recovered successfully from anaesthesia and its quality of life was deemed excellent by the owner at the last follow up, 22 months after surgery. The histopathology confirmed the diagnosis of phaeochromocytoma with an invasion of the phrenicoabdominal vein. In the present case, we obtained a successful outcome but failed to provide haemodynamic stability throughout the procedure.

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“…52 α 2 -adrenoceptor agonists also have a sympatholytic effect attributable to central α 2 -adrenoreceptor activation. This might partially counteract the effect of a catecholamine surge, [53][54][55][56] suppressing the noradrenaline levels by 49% 28,33,[56][57][58] in human patients undergoing PCC removal. By reducing the perioperative levels of stress-related hormones, α 2 -adrenoceptor agonists attenuate the stress response in dogs.…”

Section: Discussionmentioning

confidence: 99%

Perioperative use of thoracic epidural anaesthesia, dexmedetomidine and magnesium sulphate infusion in a dog undergoing neuroendocrine tumour resection

Viilmann¹,

Vettorato²

2021

Vet Record Case Reports

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An 11-year-old, 22 kg, male neutered English Staffordshire Bull Terrier, in which a pheochromocytoma was removed from the left retroperitoneal space, was referred to investigate the regrowth of a mass in the same region. A neuroendocrine tumour, compatible with pheochromocytoma, was cytologically diagnosed after ultrasound-guided fine-needle aspirates, and the dog underwent explorative celiotomy. A combination of thoracic epidural anaesthesia, dexmedetomidine and magnesium sulphate infusion was used intraoperatively to control nociception and potential haemodynamic changes caused by sudden catecholamines release. Postoperative analgesia was provided by administering 0.12% levobupivacaine through the thoracic epidural catheter and oral paracetamol and gabapentin. Postoperative methadone was administered twice during the first 24 postoperative hours only. Two days after the surgery, the dog was anaemic and packed red blood cells were administered. No other complications occurred, and the dog was discharged from the hospital 5 days following surgery. INVESTIGATIONSAbnormalities found on blood analysis are reported in Table 1. Prothrombin time was 6.0 seconds [reference interval (r.i.), 7.0-12.0], activated partial thromboplastin time was 16.0 seconds (r.i., 15.0-25.0). The blood type was dog erythrocyte antigen (DEA) 1.1-negative. In addition to CT findings, an abdominal ultrasound (US) showed nodular hepatopathy, bilateral chronic nephropathy, left mild hydronephrosis. The mass was

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Dexmedetomidine in anaesthesia for a high-risk case of pheochromocytoma with poor left ventricular function

Cited by 4 publications

References 5 publications

Anaesthetic management of a dog undergoing unilateral adrenalectomy for phaeochromocytoma excision using a partial intravenous anaesthetic protocol

Anaesthetic management of a dog undergoing unilateral adrenalectomy for phaeochromocytoma excision using a partial intravenous anaesthetic protocol

Anaesthetic Management of a Labrador Retriever Undergoing Adrenalectomy for Phaeochromocytoma Excision, a Case Report

Perioperative use of thoracic epidural anaesthesia, dexmedetomidine and magnesium sulphate infusion in a dog undergoing neuroendocrine tumour resection

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