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Canadian Journal of Anesthesia, Vol 38, 775-779, Copyright © 1991 by Canadian Anesthesiologists' Society

ARTICLES

The anaesthetic management of a patient with a phaeochromocytoma and acute stroke

JM Fox and PH Manninen
Department of Anaesthesia, University Hospital, London, Ontario, Canada.

A case is reported of a young woman in whom the diagnosis of a phaeochromocytoma was made after a major stroke. Preoperative preparation included the introduction of phenoxybenzamine, 10 mg.day-1, and propranolol, 80 mg.day-1, over a two-week period. The presence of cerebrovascular disease and the marked orthostatic changes in blood pressure and heart rate to low-dose phenoxybenzamine prevented the establishment of full alpha blockade. Incomplete alpha blockade probably contributed to the hypertensive response to manipulation of the tumour (220/150 mmHg) and hypotension occurred after removal of the tumour (80/45 mmHg). An anaesthetic technique was chosen to provide haemodynamic stability as well as protection against cerebral ischaemia. Invasive haemodynamic monitoring, a four-channel processed electroencephalograph and somatosensory evoked potentials were used to accomplish these goals.


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[Abstract] [Full Text]


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Copyright © 1991 by the Canadian Anesthesiologists' Society.