Ectopic pheochromocytoma surgery Anesthetic management experience sharp fluctuations in blood pressure.docVIP

 PAGE \* MERGEFORMAT 11 Ectopic pheochromocytoma surgery Anesthetic management experience sharp fluctuations in blood pressure Ectopic pheochromocytoma is a rare disease entities [1], at the grassroots level, general hospitals are particularly rare. Hospital in 1990 and 2004 only see the two cases, including 1 case not diagnosed preoperatively, there is no preoperative preparation. Intraoperative blood pressure by 18.7/12.0kPa (140/90mmHg) quickly rose to 36.0/21.3kPa (270/160mmHg), tumor resection after a sharp fall in blood pressure with 5min time to zero. Cause great hardship to the anesthesia management. Intraoperative condition now changes, rescue and anesthesia management process is as follows. 1 Case description Patients, male, 46 years old, weight 78kg, height 175cm, Han. To the left in the abdominal tumor on July 5, 2004 admission. Patients in the left paraumbilical able to touch a fist-sized tumor two years, did not attract attention. Past physical health, history of hypertension is unknown. Denied familial genetic history of high blood pressure. Admission physical examination: body temperature 36.5 ℃ , pulse 84 times / min, blood pressure 20.0/12.7kPa; ECG: normal; X ray (chest): normal; K, Na, Cl-, creatinine, blood urea nitrogen test results were normal; abdomen Ultrasound: the left side could be detected in the ventral cord and a 6.0cm * 6.5cm size of the solid space-occupying; CT showed: left kidney lower pole near abdominal aortic 6.0cm * 6.6cm round-like mass, its density uniform. Clinical diagnosis of retroperitoneal neurofibroma. On at 9:10 on July 11, 2004 at tracheal intubation with inhalation general anesthesia laparotomy down, ‘neurofibroma’ resection. Blood pressure before anesthesia 18.7/12.0kPa, heart rate 90 times / min, intraoperative exploration, separation cancer, high blood pressure patients, isolated tumor at 9:40 pm about 1 / 3, heart rate 140 times / min, blood pressure rose to 36.0/21.3kPa , with hyperventilation and de