Hypertensive Crisis during Removal of RetroperitonealMass in a Patient with Undiagnosed Paraganglioma -A Case Report-

다국어 초록 (Multilingual Abstract)

Paragangliomas have been reported on multiple locations. A diagnosis of a catecholamine-secreting tumor was considered only after induction of anesthesia, when BP (blood pressure) increased. A 61-year-old male patient was referred for removal of a retroperitoneal mass suspected hemangiopericytoma. He was on medications for hypertension. There was a surge of ABP (arterial blood pressure) to 186/117 mmHg when the tumor was manipulated at the beginning of the surgery, and this was treated by bolus of diltiazem. After resection of the tumor, ABP dropped to 57/36 mmHg. In order to improve the patient’s hemodynamic parameters, crystalloid fluid was given, and ephedrine was administered intravenously. Persistent hypotension was treated with titrated vasopressors (epinephrine and norepinephrine). When paraganglioma is suspected due to a sudden hypertensive crisis during surgery, the surgeon must decide whether to proceed with the surgical procedure or to stop and restart the surgery after proper management of the crisis.

참고문헌 (Reference)

1 Arai T, "Use of nicardipine in the anesthetic management of pheochromocytoma" 65 : 706-708, 1986

2 Ahmad S, "Retroperitoneal extra-adrenal paraganglioma: a rare but important diagnosis" 178 : 211-214, 2009

3 Kinney MA, "Perianesthetic risks and outcomes of pheochromocytoma and paraganglioma resection" 91 : 1118-1123, 2000

4 Pacak K, "International Symposium on Pheochromocytoma: Pheochromocytoma: recommendations for clinical practice from the First International Symposium. October 2005" 3 : 92-102, 2007

5 Holldack HJ, "Induction of anesthesia triggers hypertensive crisis in a patient with undiagnosed pheochromocytoma: could rocuronium be to blame?" 21 : 858-862, 2007

6 신혜란, "Hypertensive crisis during wide excision of gastrointestinal stromal cell tumor (GIST): Undiagnosed paraganglioma -A case report-" 대한마취통증의학회 62 (62): 289-292, 2012

7 Welbourn RB, "Early surgical history of phaeochromocytoma" 74 : 594-596, 1987