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Anesthesia for pheochromocytoma resection in a child with Fontan circulation

  • Thomas R. Latendresse
  • Adam B. Goldin
  • Christer Jonmarker
Case Reports/Case Series

Abstract

Purpose

To report the anesthetic management of a successful resection of a pheochromocytoma in a child with a completed Fontan circulation.

Clinical features

The patient was an 11-yr-old boy with Ivemark syndrome who had undergone Fontan palliation at three years of age. Six weeks earlier, he had been diagnosed with a norepinephrine-producing pheochromocytoma, and he had been pretreated with oral propranolol and phenoxybenzamine. During surgery, intravenous administration of magnesium sulphate, esmolol, and phentolamine provided good hemodynamic control. Postoperatively, the patient tended to be hypotensive, and treatment with fluid administration resulted in prolonged intensive care.

Conclusion

Although intraoperative management was not problematic, postoperative care of this 11-yr old child with pheochromocytoma was complicated by residual sympathetic blockade.

Keywords

Obstructive Sleep Apnea Continuous Positive Airway Pressure Remifentanil Esmolol Doxazosin 

L’anesthésie pour une résection de phéochromocytome chez un enfant avec une circulation de Fontan

Résumé

Objectif

Rapporter la prise en charge anesthésique d’une résection réussie d’un phéochromocytome chez un enfant avec une circulation de Fontan complétée.

Éléments cliniques

Le patient était un garçon de 11 ans atteint d’un syndrome d’Ivemark ayant subi une palliation de Fontan à l’âge de trois ans. Six semaines plus tôt, un diagnostic de phéochromocytome produisant de la norépinéphrine avait été posé, et l’enfant avait été prétraité à l’aide de propranolol oral et de phénoxybenzamine. Pendant la chirurgie, l’administration intraveineuse de sulfate de magnésium, d’esmolol et de phentolamine a permis de maintenir un bon contrôle de l’hémodynamie. En période postopératoire, le patient a eu tendance à être hypotendu, et un traitement liquidien a entraîné un séjour prolongé aux soins intensifs.

Conclusion

Bien que la prise en charge peropératoire n’ait pas été problématique, les soins postopératoires prodigués à cet enfant de 11 ans atteint d’un phéochromocytome ont été compliqués par un bloc sympathique résiduel.

Notes

Conflict of interest

None declared.

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Copyright information

© Canadian Anesthesiologists' Society 2011

Authors and Affiliations

  • Thomas R. Latendresse
    • 1
  • Adam B. Goldin
    • 2
  • Christer Jonmarker
    • 1
  1. 1.Department of Anesthesiology and Pain MedicineSeattle Children’s Hospital and the University of Washington School of MedicineSeattleUSA
  2. 2.Department of SurgerySeattle Children’s Hospital and the University of Washington School of MedicineSeattleUSA

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