Anesthetic management for resection of para-aortic paraganglioma and unexpected aortic resection: A case report.
Anesthetic management for resection of para-aortic paraganglioma and unexpected aortic resection: A case report.
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DOI：
10.3892/etm.2015.2289
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发表时间：
2015-04
影响因子：
2.7
通讯作者：
Eldesouki E
中科院分区：
文献类型：
--
作者：
Wang C;Richmond R;Eldesouki E
副神经节瘤占嗜铬细胞瘤的15-20%，来源于嗜铬细胞并分泌儿茶酚胺。由于高血压和具有挑战性的麻醉管理，它有很高的死亡率。本报告是一例成功的管理副神经节瘤切除与意外的主动脉切除术。患者提出副神经节瘤切除术。术前先用α阻断剂，后用β阻断剂控制血压。患者处于全麻状态，有多条静脉导管、导管和动脉导管。诱导是通过麻醉和挥发性药物的施用实现的。在手术过程中，发现主动脉需要切除以完成肿瘤切除。在夹紧和开夹、结扎肿瘤静脉和切除肿瘤后，血压变化明显。酚妥拉明、硝普塞、艾司洛尔和拉贝洛尔控制儿茶酚胺释放和解夹引起的血压升高。由于肿瘤静脉结扎和夹紧引起的血压下降用去甲肾上腺素和加压素处理。在密切沟通和监护下，患者顺利完成手术，并于数日后出院，血流动力学稳定。病理进一步证实了诊断。这是一个具有挑战性的病例副神经节瘤切除与意外的主动脉切除术。取得的成功表明，切除副神经节瘤和主动脉段需要精细的麻醉管理。关键是术前控制血压所需的α阻断和β阻断，麻醉师和外科医生之间的频繁沟通，手术前用酚妥拉明、硝普塞和拉贝他洛尔干预过量儿茶酚胺释放，钳夹时或肿瘤切除后儿茶酚胺缺乏的利尿加压素。这是一个需要团队合作的精心策划的过程。
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.
影响因子：
2.6
作者：
Martucci, Victoria L.;Pacak, Karel
通讯作者：
Pacak, Karel
影响因子：
0.6
作者：
Jugovac, Izabela;Antapli, Mursel;Markan, Sandeep
通讯作者：
Markan, Sandeep
影响因子：
4.6
作者：
Bowen, FW;Civan, J;Gleason, T
通讯作者：
Gleason, T