Rapid preparation of a patient with pheochromocytoma with labetolol and magnesium sulfate

Citation
R. Poopalalingam et Eyr. Chin, Rapid preparation of a patient with pheochromocytoma with labetolol and magnesium sulfate, CAN J ANAES, 48(9), 2001, pp. 876-880
Citations number
10
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Journal title
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE
ISSN journal
0832-610X → ACNP
Volume
48
Issue
9
Year of publication
2001
Pages
876 - 880
Database
ISI
SICI code
0832-610X(200110)48:9<876:RPOAPW>2.0.ZU;2-3
Abstract
Purpose: To describe the rapid perioperative optimization and control of bl ood pressure in a young patient who presented with pheochromocytoma. He was non-compliant with phenoxybenzamine but insisted on early surgery. He was scheduled for laparoscopic resection of the tumour. Clinical features: This 32-yr-old man presented with uncontrolled hypertens ion for a few years for which he was treated with nifedipine. He subsequent ly defaulted flow-up, The patient presented again approximately three month s from the day of surgery and was diagnosed to have a pheochromocytoma. The endocrinologist prescribed phenoxylbenzamine and propanolol in addition to the nifedipine but the patient stopped taking both drugs six weeks prior t o surgery due to their side effects. The patient was admitted the evening b efore surgery to the intensive care unit for rapid control of his blood pre ssure. Blood pressure was optimized with an infusion of labetolol and volum e expansion titrated under central venous catheter and intraarterial blood pressure guidance throughout the night. On the morning of surgery, a magnes ium sulfate infusion was started. The laparoscopic surgery proceeded uneven tfully and the patient was hemodynamically stable. There were two transient periods of hypotension after induction and at removal of tumour respective ly which were corrected with a brief adrenaline infusion. No adverse outcom e was noted. Conclusion: This case highlights the possibility of a more rapid perioperat ive control of pheochromocytoma using high doses of labetolol and a magnesi um sulfate infusion to achieve stable intraoperative hemodynamics during la paroscopic resection of pheochromocytoma.