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Canadian Journal of Anaesthesia

, Volume 36, Issue 2, pp 215–218 | Cite as

Perioperative management for resection of a malignant nonchromaffin paraganglioma of the bladder

  • William M. Splinter
  • Brian Milne
  • Curtis Nickel
  • Chris Loomis
Article

Abstract

The perioperative management of a 39-year-old patient with a rare, catecholamine producing, non-chromaffin paraganglioma of the bladder is presented. Although the management of this patient was comparable with a patient with a phaeochromocytoma, this case was complicated by marked release of catecholamines, high requirements for vasodilator therapy preoperatively, the presence of a malignant tumour with metastases and an atypical presentation. Preoperatively the diagnosis was a non-metastatic bladder phaeochromocytoma and the blood pressure was controlled with prazosin, nifedipine and propranolol. Anaesthesia was induced with fentanyl. lidocaine, thiopentone and vecuronium and was maintained with nitrous oxide, isoflurane, fentanyl and vecuronium. The patient was haemodynamically stable throughout the operative and postoperative period.

Key words

anaesthesia: evaluation preoperative anaesthetics volatile: isoflurane pharmacology: nifedipine surgery: paraganglioma phaeochromocytoma sympathetic nervous system: alpha-adrenergic antagonists beta-adrenergic antagonists pharmacology catecholamines epinephrine norepinephrine 

Résumé

La conduite periopératoire chez un patient âgé de 39 ans atteint ďun paragangliome non-chromaffine produisant des catecholamines de la vessie est présentée. Même si a conduite chez ce patient était comparable à un patient atteint de phéochromocytome, ce cas fut compliqué par une libération marquée de catécholamines, nécessitant de fortes doses de vasodilatateur en période préopératoire, la présence ďune tumeur maligne avec métastases et une présentation atypique. En période préopératoire le diagnostic était un phéochromocytome non-métastatique de la vessie et la pression artérielle ful contrôlée par la prazosine, nifédipine et propranolol. Ľanesthésie fut induite avec le fentanyl, lidocaïne, thiopenthone et vécuronium et était maintenue avec protoxyde ďazote, isoflurane, fentanyl et vécuronium. Le patient était stable hémodynamiquement à travers la période opératoire et en période postopératoire.

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Copyright information

© Canadian Anesthesiologists 1989

Authors and Affiliations

  • William M. Splinter
    • 1
    • 2
  • Brian Milne
    • 1
  • Curtis Nickel
    • 1
  • Chris Loomis
    • 1
  1. 1.Departments of AnaesthesiaPharmacology and Toxicology, and Urology, Queen’s UniversityKingston
  2. 2.Department of AnaesthesiaChildren’s Hospital of Eastern OntarioOttawa

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