thiopental and Pheochromocytoma

We describe the case of a 5-year-old boy with phaeochromocytoma of the left adrenal gland, treated surgically by removal of the tumour under general anaesthesia. Phaeochromocytoma is a particularly rare tumour in children and surgical excision is the definitive treatment. We discuss the clinical and laboratory characteristics of the case, the diagnostic approach, the preoperative and intraoperative management and the postoperative course.

Topics: Adjuvants, Anesthesia; Adrenal Gland Neoplasms; Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Child, Preschool; Fentanyl; Humans; Isoflurane; Male; Neuromuscular Depolarizing Agents; Pheochromocytoma; Thiopental; Vecuronium Bromide

Topics: Adrenal Gland Neoplasms; Adult; Anesthesia, Intravenous; Carotid Body Tumor; Humans; Male; Neoplasms, Multiple Primary; Pancuronium; Pheochromocytoma; Thiopental; Tubocurarine

This report describes the anaesthetic management of a women with a term gestation, Von Hippel Lindau disease (VHLD), and a phaeochromocytoma, scheduled for a combined phaeochromocytoma resection and Caesarean section. Von Hippel Lindau disease is characterized by diffuse haemangioblastomas of the central nervous system (CNS) and viscera. It is also associated with phaeochromocytomas and renal cell carcinomas. Patients frequently have asymptomatic spinal cord and intracranial pathology. The patient and her fetus presented a challenge because of the anaesthetic restrictions imposed by VHLD, and her pregnancy. She was also at risk of developing malignant hypertension from the phaeochromocytoma. The patient was not a candidate for regional anaesthesia because of the possibility of spinal cord haemangioblastomas. She had received adrenergic blockade with phentolamine (total 30 mg a day) and propranolol (total 40 mg a day) since the 27th wk of gestation in order to control hypertension secondary to the phaeochromocytoma. General anaesthesia was administered with aggressive management of hypertension with adrenergic blockers (labetalol 1.0 mg.kg-1 and esmolol 0.75 mg.kg-1) and sodium nitroprusside 1.5 micrograms.kg-1 (total). Before delivery of the baby, opioids, which could have resulted in a fetus with CNS depression, were avoided. After delivery, opioids (sufentanil 0.4 microgram.kg-1 x hr-1) were used to limit the use of inhalational anaesthesia which may contribute to uterine atony. Postoperative pain was managed with an intravenous narcotic infusion. Both patients had uneventful postoperative courses.

Topics: Adrenal Gland Neoplasms; Adult; Anesthesia, General; Anesthesia, Inhalation; Anesthesia, Intravenous; Anesthesia, Obstetrical; Cesarean Section; Female; Humans; Lidocaine; Midazolam; Pheochromocytoma; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Complications, Neoplastic; Succinylcholine; Sufentanil; Thiopental; von Hippel-Lindau Disease

Two patients with pheochromocytoma have been operated. Experience is recorded with the general anesthesia in this rare disease. The need of sufficient and competent preoperative preparation and precise choice of anesthetic agents is emphasized. Difficulties in controlling complications affecting the cardiovascular system are pointed out.

Topics: Adrenal Gland Neoplasms; Adult; Anesthesia, General; Humans; Male; Middle Aged; Neuroleptanalgesia; Nitrous Oxide; Pheochromocytoma; Preanesthetic Medication; Thiopental

Topics: Adrenal Gland Neoplasms; Alcuronium; Anesthesia, General; Blood Pressure; Child, Preschool; Humans; Male; Pheochromocytoma; Thiopental

A patient with phaeochromocytoma was anaesthetized on four seperate occasions. Some of the problems associated with this disease are discussed and recommendations for anaesthetic management are made.

Topics: Adrenal Gland Neoplasms; Anesthesia; Anesthesia, Inhalation; Halothane; Humans; Male; Meperidine; Middle Aged; Oxygen; Pancuronium; Pheochromocytoma; Promethazine; Sigmoid Neoplasms; Thiopental

Topics: Adult; Anesthesia, Endotracheal; Female; Humans; Methods; Pheochromocytoma; Preanesthetic Medication; Preoperative Care; Thiopental

Topics: Adolescent; Adult; Anesthesia, General; Anesthetics; Arrhythmias, Cardiac; Chlorprothixene; Female; Hemodynamics; Humans; Hypertension; Male; Methoxyflurane; Middle Aged; Phenoxybenzamine; Pheochromocytoma; Postoperative Care; Preanesthetic Medication; Premedication; Propranolol; Succinylcholine; Thiopental

Topics: Adjuvants, Anesthesia; Adolescent; Adrenal Gland Neoplasms; Anesthesia, General; Appendicitis; Humans; Hypertension; Male; Nitrous Oxide; Pheochromocytoma; Preanesthetic Medication; Thiopental