Anesthetic management for resection of para‑aortic paraganglioma and unexpected aortic resection: A case report

  • Authors:
    • Cheryl Wang
    • Robert Richmond
    • Enas Eldesouki
  • View Affiliations

  • Published online on: February 13, 2015     https://doi.org/10.3892/etm.2015.2289
  • Pages: 1542-1544
Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )
Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )


Abstract

Paragangliomas account for 15‑20% of pheochromocytomas derived from chromaffin cells and secretes catecholamines. It has a high mortality rate due to hypertension and challenging anesthetic management. The present report is of a case of the successful management of paraganglioma resection with unexpected aortic resection. The patient presented for paraganglioma resection. The blood pressure (BP) was well controlled with α blockade followed by β blockade prior to surgery. The patient was under general anesthesia, with multiple intravenous lines, catheters and an arterial line. Induction was achieved by the administration of narcotic and volatile agents. During the procedure, the aorta was found to require resection in order to complete the tumor resection. The BP changed markedly with clamping and unclamping, tumor vein ligation and tumor resection. The increased BP due to catecholamine release and unclamping was controlled with phentolamine, nitroprusside, esmolol and labetolol. Drops in BP due to tumor vein ligation and clamping were managed with norepinephrine and vasopressin. With close communication and monitoring, the surgery on the patient was successfully completed and the patient was discharged days later in a hemodynamically stable condition. The diagnosis was further confirmed by pathology. This was a challenging case of paraganglioma resection with unexpected aortic resection. The success achieved suggests that the resection of paraganglioma and an aortic segment requires delicate anesthetic management. The key are α blockade and β blockade as necessary to control BP pre‑operatively, frequent communication between the anesthesiologist and surgeons, intra‑operative intervention in excess catecholamine release with phentolamine, nitroprusside and labetalol prior to tumor removal, and vasopressin for catecholamine deficiency when clamping or subsequent to tumor removal. It is a delicately orchestrated process requiring team work.
View Figures
View References

Related Articles

Journal Cover

April-2015
Volume 9 Issue 4

Print ISSN: 1792-0981
Online ISSN:1792-1015

Sign up for eToc alerts

Recommend to Library

Copy and paste a formatted citation
x
Spandidos Publications style
Wang C, Richmond R and Eldesouki E: Anesthetic management for resection of para‑aortic paraganglioma and unexpected aortic resection: A case report. Exp Ther Med 9: 1542-1544, 2015
APA
Wang, C., Richmond, R., & Eldesouki, E. (2015). Anesthetic management for resection of para‑aortic paraganglioma and unexpected aortic resection: A case report. Experimental and Therapeutic Medicine, 9, 1542-1544. https://doi.org/10.3892/etm.2015.2289
MLA
Wang, C., Richmond, R., Eldesouki, E."Anesthetic management for resection of para‑aortic paraganglioma and unexpected aortic resection: A case report". Experimental and Therapeutic Medicine 9.4 (2015): 1542-1544.
Chicago
Wang, C., Richmond, R., Eldesouki, E."Anesthetic management for resection of para‑aortic paraganglioma and unexpected aortic resection: A case report". Experimental and Therapeutic Medicine 9, no. 4 (2015): 1542-1544. https://doi.org/10.3892/etm.2015.2289