Effects of Sodium Nitroprusside During the Excision of Phaeochromocytoma

Abstract

Phaeochromocytoma is a tumour of the adrenal medullary cells of chromaffin origin, which, although histologically benign, may be dangerous because of excessive secretion of adrenaline and noradrenaline. The growth may not be confined to the adrenals but may occur wherever chromaffin tissue is found, for example along the sympathetic chain, the para-aortic areas, the aortic bifurcation, the retroperitoneum and even in the bladder.Clinical features, resulting from the release of catecholamines, include hypertension, paroxysmal or continuous, hyperhydrosis, hyperglycaemia, increased oxygen consumption, haemoglobin percentage and haematocrit reading, and an elevated basal metabolic rate.The diagnosis is confirmed by measurement of single 24-hour urinary catecholamine or 3-methoxy, 4-hydroxymandelic acid (VMA) values, by certain radiological techniques, and by the effect of certain pharmacological agents, for example histamine to release stored catecholamines and to raise the blood pressure or phentolamine to lower it. Case reportThe patient, a 32-year-old male weighing 79.5 kg, gave a history of low back pain for 2 years and of attacks of sudden uncontrollable aggressive behaviour during the past 18 months with periodic blurred vision.The family history showed that his father, grandfather and great-grandfather had suffered from similar attacks of aggressive behaviour, and a sister had undergone removal of a phaeochromocytoma.Clinical examination revealed a blood pressure of 215/130 mmHg, and a lumbar disc herniation was found at L4-5 level. The attacks of aggressive behaviour were not controlled by drug therapy. Intravenous pyelography showed no abnormality, but on arteriography a large tumour was demonstrated in the right suprarenal area.

Anaesthesia for phaeochromocytoma removal in a 5‐year‐old boy

“…If hypertension is present in spite of satisfactory depth of anaesthesia, phentolamine should be given in single intravenous doses. If this fails, sodium nitroprusside infusion should be started (22). Sodium nitroprusside has a more favourable pharmacokinetic profile than phentolamine, due to its shorter onset time and duration of action, but can cause more profound changes of BP and prolonged action is associated with tachyphylaxis and cyanide toxicity.…”

Mechanism of the Hypertensive Effect of Droperidol in Pheochromocytoma

“…Droperidol has the ability to reduce the pressor effects of catecholamines in man (Whitwam and Russell 1971), due to specific blockade of alpha-adrenoreceptors (Gothert, Thies and Veth 1976). It has been used successfully in the anaesthetic management of pheochromocytoma (Clarke et al 1972, Csanky-Treels et al 1976, Stamenkovic and Spierdijk 1976. However in two patients with pheochromocytoma, droperidol induced an increase in B.P.…”

Quantitative Erfassung der Katecholaminsekretion als rationale Grundlage des Anästhesiemanagements bei Phäochromozytomexstirpation

“…Unsere Ergebnisse ordnen sich damit in die Forschungsergebnisse anderer Autoren ein (6,20). Einerseits ist der Mechanismus einer katecholaminbedingten Blutdruckerhöhung belegt.…”