Effects of sodium nitroprusside during the excision of phaeochromocytoma

Csanky-Treels, J. C.; Pabst, W P Lawick van; Brands, Jelle; Stamenkovic, L

doi:10.1111/j.1365-2044.1976.tb11746.x

Cited by 17 publications

(1 citation statement)

References 3 publications

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“…Failure of the blood pressure to fall after removal of the tumor suggests the possibility of other tumors and in one report 3 further tumors were so demonstrated [75]. An intra-adrenal pheochromocytoma should be treated by excision of the whole gland and bilateral tumors by bilateral total adrenalectomy.…”

Section: Surgerymentioning

confidence: 96%

The management of the patient with catecholamine excess

et al. 1982

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The key to the diagnosis of pheochromocytoma is a high index of suspicion on the part of the clinician. Confirmation of the diagnosis and localization of the tumor have been rendered relatively straightforward by advances in biochemistry, nuclear medicine, and radiology. Close cooperation and team effort between a physician, anesthetist, and surgeon possessing expertise in this field will ensure optimal preoperative, operative, and postoperative care, particularly for the small group of patients seriously ill with “acute” catecholamine excess.

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Section: Surgerymentioning

confidence: 96%

The management of the patient with catecholamine excess

et al. 1982

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Nitroprusside Therapy for a Patient With a Pheochromocytoma

Lipson¹,

Hsu²,

Sherwin³

et al. 1978

JAMA

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A 32-year-old woman was transferred to the George Washington University Hospital Intensive Care Unit from another hospital, with uncontrolled hypertension six hours after cesarean section. The patient had a history of labile hypertension and di et \ x=req-\ controlled diabetes. She was hypertensive during her first pregnancy, miscarrying at six months.During the current pregnancy, blood pressure became 140/90 mm Hg, and occasional flushing, pedal edema, and proteinuria occurred. At 32 weeks, she was admitted with a blood pressure of 220/140 mm Hg, unchanged by diazepam and bed rest. Despite methyldopa therapy, 500 mg every six hours, blood pressure was 180/130 mm Hg. An intravenous drip of hydralazine hydrochloride, 200 mg, and cryptenamine acetate, 10 mg, produced headache, flushing, and chest pain. Therapy was subsequently discontinued. When blood pressure reached 240/190 mm Hg, she received 5 g of magne¬ sium sulfate, intravenously, and underwent successful cesarean delivery of a 6.6 kg boy.The blood pressure remained 160/130 mm Hg and she was transferred to George Washington Hospital.On physical examination, she was per¬ spiring, flushed, and lethargic. Blood pres¬ sure was 150/130 mm Hg and pulse was regular at 160 beats per minute. Pupils were widely dilated and reactive, and fundi showed bilateral papilledema with hem¬ orrhages and exudates. There was a summation gallop and recent abdominal surgical scar. The results of the rest of the examination were normal. Admission laboratory levels included hematocrit, 47.4%; leukocyte count, 18,200/ cu mm; normal levels of serum electrolytes, creatinine, and blood glucose; and BUN, 24 mg/dl. Urinalysis showed a specific gravity of 1.022, proteinuria (4 + ), and 5 WBCs and 10 RBCs per high-powered microscopic field. A chest roentgenogram showed clear lung fields, and an ECG showed a sinus tachycardia at a rate of 160 beats per minute, with left ventricular strain.On admission a sodium nitroprusside drip was started at 0.6 Mg/kg/min. Blood pres¬ sure decreased to 120/110 mm Hg during a 30-minute period and then stabilized. Four hours later, methyldopa therapy, 250 mg every six hours, was begun, and the patient was vigorously hydrated. After 12 hours, nitroprusside therapy was stopped and blood pressure was 120/100 mm Hg. Magne¬ sium sulfate, 1 g intravenously hourly, was given to prevent eclamptic seizures. During the next 36 hours, blood pressure remained 120/90 mm Hg, and both methyldopa and magnesium therapies were discontinued. After hydration, the hematocrit reading was 37%, and the pulse rate was 125 beats per minute.She was transferred to the obstetrics service and remained normotensive until the fourth hospital day, when the blood pressure became 160/110 mm Hg. Hyper¬ tension was unresponsive to methyldopa, 250 mg every six hours; phénobarbital, 90 mg twice daily; and hydrochlorthiazide, 50 mg daily. On the sixth hospital day, pulmonary edema ensued, necessitating transfer to the Intensive Care Unit for treatment with digoxin, furosemide, mor¬ phine sulfate, a...

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Lutz¹

1984

Anästhesiologische Praxis

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Effects of sodium nitroprusside during the excision of phaeochromocytoma

Cited by 17 publications

References 3 publications

The management of the patient with catecholamine excess

The management of the patient with catecholamine excess

Nitroprusside Therapy for a Patient With a Pheochromocytoma

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