Abstract
The management of a patient with two undiagnosed neuroendocrine tumors and possible malignant hyperthermia (MH) susceptibility poses a unique challenge to the anesthesiologist. We describe a total intravenous anesthetic including an alpha 2-agonist infusion combined with epidurally administered bupivacaine for intra- and postoperative pain management. Alpha 2-agonists may offer improved intraoperative hemodynamic management in patients with catecholamine-secreting tumors and reduce the total dose needed for intravenous anesthetics such as propofol. The latter mechanism may be useful to avert the risk of the propofol infusion syndrome occurring as a consequence of a high cumulative dose following its prolonged administration.
Similar content being viewed by others
References
MT Barakat K Meeran SR Bloom (2004) ArticleTitleNeuroendocrine tumors Endocr Relat Cancer 11 1–18 Occurrence Handle15027882 Occurrence Handle10.1677/erc.0.0110001 Occurrence Handle1:CAS:528:DC%2BD2cXjs1Squrg%3D
K Oberg (2003) ArticleTitleDiagnosis and treatment of carcinoid tumors Expert Rev Anticancer Ther 3 863–877 Occurrence Handle14686708 Occurrence Handle10.1586/14737140.3.6.863
DC Voros B Smirniotis E Argyra A Vadalouka L Siafaka J Papadimitriou (1995) ArticleTitleUndiagnosed pheochromocytomas in the perioperative period Eur J Surg 162 985–987
TG Short Y Young (2003) ArticleTitleToxicity of intravenous anaesthetics Best Pract Res Clin Anaesthesiol 17 77–89 Occurrence Handle12751550 Occurrence Handle10.1053/bean.2002.0266 Occurrence Handle1:CAS:528:DC%2BD3sXitFagsbw%3D
B Vasile F Rasulo A Candiani N Latronico (2003) ArticleTitleThe pathophysiology of propofol infusion syndrome: a simple name for a complex syndrome Intensive Care Med 29 1417–1425 Occurrence Handle12904852 Occurrence Handle10.1007/s00134-003-1905-x
D Ernest C French (2003) ArticleTitlePropofol infusion syndrome—report of an adult fatality Anaesth Intensive Care 31 316–319 Occurrence Handle12879680 Occurrence Handle1:STN:280:DC%2BD3szkvVSmsA%3D%3D
TM Kang (2002) ArticleTitlePropofol infusion syndrome in critically ill patients Ann Pharmacother 36 1453–1456 Occurrence Handle12196066 Occurrence Handle10.1345/aph.1A321
M Koch D DeBacker JL Vincent (2004) ArticleTitleLactic acidosis: an early marker of propofol infusion syndrome? Intensive Care Med 30 522 Occurrence Handle14685664 Occurrence Handle10.1007/s00134-003-2130-3
A Liolios JM Guerit JL Scholtes C Raftopoulos P Hantson (2005) ArticleTitlePropofol infusion syndrome associated with short-term large-dose infusion during surgical anesthesia in an adult Anesth Analg 100 1804–1805 Occurrence Handle15920217 Occurrence Handle10.1213/01.ANE.0000153017.93666.BF
MAE Ramsay DL Luterman (2004) ArticleTitleDexmedetomidine as a total intravenous anesthetic agent Anesthesiology 101 787–790 Occurrence Handle15329604 Occurrence Handle10.1097/00000542-200409000-00028
VSB Jorden A Tung (2002) ArticleTitleDexmedetomidine: clinical update Semin Anesth Periop Med Pain 21 265–274 Occurrence Handle10.1053/sane.2002.34195 Occurrence Handle1:CAS:528:DC%2BD3sXhtVShtbw%3D
SR Arain TJ Ebert (2002) ArticleTitleThe efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation Anesth Analg 95 461–466 Occurrence Handle12145072 Occurrence Handle10.1097/00000539-200208000-00042 Occurrence Handle1:CAS:528:DC%2BD38XmtlGhurg%3D
J Sprung MO Kinney MA Warner (2002) ArticleTitleAnesthetic aspects of laparoscopic adrenalectomy for pheochromocytoma Semin Anesth Periop Med Pain 21 35–45 Occurrence Handle10.1053/sane.2002.30379
AYC Wong CW Cheung (2004) ArticleTitleDexmedetomidine for resection of a large pheochromocytoma with invasion into the inferior vena cava Br J Anaesth 93 873 Occurrence Handle15533960 Occurrence Handle10.1093/bja/aeh634 Occurrence Handle1:STN:280:DC%2BD2crmtFeitw%3D%3D
R Schumann N Joseph L Zabala SD Schwaitzberg RM Lechan (2003) ArticleTitleHypertensive crisis inducing rhabdomyolysis during laparoscopic resection of a large pheochromocytoma: a case report J Clin Anesth 15 540–544 Occurrence Handle14698369 Occurrence Handle10.1016/j.jclinane.2003.02.006
GW Graham BP Unger DB Coursin (2000) ArticleTitlePerioperative management of selected endocrine disorders Int Anesthesiol Clin 4 31–67 Occurrence Handle10.1097/00004311-200010000-00004
Author information
Authors and Affiliations
About this article
Cite this article
Hudcova, J., Schumann, R. Undiagnosed catecholamine-secreting paraganglioma and coexisting carcinoid in a patient with MH susceptibility: an unusual anesthetic challenge. J Anesth 21, 80–82 (2007). https://doi.org/10.1007/s00540-006-0462-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-006-0462-1