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Title: Anaesthetic management of cardiac phaeochromocytoma: A case series.
Austin Authors: Chen, Guangjun;Wang, Jingjie;Weinberg, Laurence ;Robinson, Callum;Ho, Timothy;Lin, Wangjia;Gong, Zhiyi;Liu, Wei;Zhu, Bo;Huang, Yuguang
Affiliation: Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
Department of Anaesthesiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Department of Anaesthesiology, Peking Union Medical College Hospital, Beijing, China
Issue Date: 19-Aug-2018
Date: 2018-08-19
Publication information: International journal of surgery case reports 2018; 51: 134-138
Abstract: Primary cardiac phaeochromocytoma is uncommon, with few anaesthetists encountering this rare pathology in clinical practice. Further, there is little information available on the detailed intraoperative and postoperative haemodynamics and principles of the anaesthetic management of this condition. We present a retrospective, single-centre case series of four patients with cardiac phaeochromocytoma who presented for surgical excision. We describe the perioperative evaluation and management of these patients, consideration of the requirements for cardiopulmonary bypass, and the analgesic and pharmacologic interventions needed to maintain stable perioperative and intraoperative haemodynamics. Octreotide scintigraphy, in addition to echocardiography, cardiac MRI and coronary angiography proved vital in the preoperative evaluation of these patients. Preoperative anaesthetic management of cardiac phaeochromocytoma involved alpha-adrenergic blockade, judicious beta-adrenergic blockade and hydration. Intraoperatively, the administration of vasodilatory agents prior to, and vasoconstricting agents with volume therapy after tumour excision, were the key elements of anaesthetic management. Furthermore, we believe that cardiopulmonary bypass plays a pertinent role in cardiac phaeochromocytoma excision and that the risks and benefits of pulmonary artery catheters should be considered before use in these patients. Management of cardiac phaeochromocytoma is complex and demands careful perioperative planning and management. Perioperative morbidity is common and anaethetists play an important role in achieving a successful outcome for patients who present for excision of cardiac phaeochromocytoma.
DOI: 10.1016/j.ijscr.2018.08.019
ORCID: 0000-0001-7403-7680
Journal: International journal of surgery case reports
PubMed URL: 30153610
ISSN: 2210-2612
Type: Journal Article
Subjects: Anaesthesia
Cardiac phaeochromocytoma
Cardiac surgery
Case report
Appears in Collections:Journal articles

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