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Catecholamine crisis during induction of general anesthesia

A case report

Katecholaminkrise bei Einleitung zur Allgemeinanästhesie

Eine Kasuistik

  • Kasuistiken
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Abstract

Catecholamine crises associated with pheochromocytoma may cause life-threatening cardiovascular conditions. We report the case of a 75-year-old male who developed a hypertensive crisis during induction of general anesthesia for elective resection of a cervical neuroma due to an undiagnosed pheochromocytoma. Hemodynamic instability occurred immediately after the injection of fentanyl, propofol and rocuronium, prior to laryngoscopy and in the absence of any manipulation of the abdomen. In this case report, we present the management of this incident and discuss the underlying pathophysiology triggering a catecholamine crisis.

Zusammenfassung

Katecholaminkrisen aufgrund eines Phäochromozytoms können zu lebensbedrohlichen kardiovaskulären Zuständen führen. Wir berichten über einen 75-jährigen Mann, der im Rahmen der Anästhesieeinleitung zur elektiven Resektion eines zervikalen Neurinoms eine hypertensive Krise auf dem Boden eines nicht-diagnostizierten Phäochromozytoms entwickelte. Die hämodynamische Instabilität trat kurz nach Injektion von Fentanyl, Propofol und Rocuronium auf, allerdings vor Laryngoskopie und ohne jegliche Manipulation des Abdomens. In dieser Kasuistik präsentieren wir die Handhabung dieses Zwischenfalls und diskutieren die zugrunde liegende Pathophysiologie, die die Katecholaminkrise auslöste.

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Abbreviations

BP:

Blood pressure

bpm:

Beats per minute

CC:

Catecholamine crisis

CT:

Computed tomography

HI:

Hemodynamic instability

HR:

Heart rate

NDMR:

Non-depolarizing muscle relaxants

PASS:

Pheochromocytoma of the adrenal gland scaled score

PHEO:

Pheochromocytoma

SNS:

Sympathetic nervous system

UD-PHEO:

Undiagnosed pheochromocytoma

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Authors and Affiliations

  1. Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt/Main, Germany

    M. Sonntagbauer MD, A. Koch, U. Strouhal, K. Zacharowski & C. F. Weber

  2. Department of Anesthesiology, Intensive Care and Emergency Medicine, Asklepios Klinik Wandsbek, Hamburg, Germany

    C. F. Weber

Authors
  1. M. Sonntagbauer MD
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  2. A. Koch
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  3. U. Strouhal
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  4. K. Zacharowski
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  5. C. F. Weber
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Corresponding author

Correspondence to M. Sonntagbauer MD.

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Conflict of interest

M. Sonntagbauer, A. Koch, U. Strouhal, K. Zacharowski and C.F. Weber declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors. Consent was obtained from all patients identifiable from images or other information within the manuscript. In the case of underage patients, consent was obtained from a parent or legal guardian.

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Sonntagbauer, M., Koch, A., Strouhal, U. et al. Catecholamine crisis during induction of general anesthesia. Anaesthesist 67, 209–215 (2018). https://doi.org/10.1007/s00101-018-0409-6

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  • DOI: https://doi.org/10.1007/s00101-018-0409-6

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