ANAESTHETIC MANAGEMENT OF PHEOCHROMOCYTOMAA REVIEW OF 3 CASES

2021 ◽  
pp. 10-11
Author(s):  
Kumari Sneha ◽  
Gunjan Singh ◽  
Kalyan Kumar Saha ◽  
Vanita R Mhaske ◽  
Bikram Gupta
Keyword(s):  
Blood Pressure ◽  
Adrenal Medulla ◽  
Pediatric Patients ◽  
Case Reports ◽  
Residual Tumor ◽  
Anaesthetic Management ◽  
Imaging Studies ◽  
Noninvasive Blood Pressure ◽  
Invasive Pressure Monitoring ◽  
Electrocardiogram Ecg

INTRODUCTION: Pheochromocytoma is pharmacologically volatile, potentially lethal catecholamine- Containing tumor of chromafn tissues 1 . Pediatric pheochromocytomas, although rare, have an increased incidence of bilateral, multifocal, and familial preponderance when compared to 2 adults. It occurs in less than 2% of pediatric patients with hypertension and is a diagnosis of exclusion . They are usually located in adrenal medulla 3 or sympathetic paraganglia but may be found anywhere chromafn tissue exists. These locations extend from the base of skull to anus . Traditionally it was thought that 90% of pheochromocytoma are found in adrenal medulla and 10% occuredelse where. Prevalence of extra adrenal 4 tumorsis now thought to be as high as 20%.theseare commonly called paragangliomas . RESULT: The child was premedicated with midazolam 30mcg/kg intravenously and was transferred to the operating room on an infusion of normal saline 60 mL/hr and hydrocortisone 10mg/hr according to the endocrinologist's advice. After instituting electrocardiogram (ECG), noninvasive blood pressure (NIBP), and pulse oximeter (SpO2) monitors, the child was pre-oxygenated and anesthesia was induced with propofol2 mg/Kg and fentanyl 2 mcg/Kg. Endotracheal intubation was facilitated with vecuronium0.1 mg/Kg. Right internal juglar vein and right radial artery were cannulated for continuous invasive pressure monitoring. A19G epidural catheter was inserted in T8-T9 interspace for analgesia. CONCLUSION: On the basis of these case reports, we want to emphasize that while dealing with surgeries of pheochromocytomahaemodynamic instability should be kept in mind. Preoperative blood pressure optimization is necessity along with intraoperative beat to beat monitoring and use of titrated doses of antihypertensive accordingly. Persistent hypertension after removal of pheochromocytoma occasionally signies that a residual tumor is present, so post operative biochemical assay and imaging studies are repeated for conrmation and further management.

scholarly journals Anaesthetic Management of a case of Cesarean Section with Peripartum Cardiomyopathy

JMS SKIMS ◽  
2012 ◽  
Vol 15 (1) ◽  
pp. 69-71
Author(s):  
Ayaz Khalid Farooqi ◽  
Waqar Ul Nisa ◽  
Irshad Ahmad
Keyword(s):  
Blood Pressure ◽  
Cesarean Section ◽  
Pulse Oximetry ◽  
Epidural Anaesthesia ◽  
Pressure Pulse ◽  
Anaesthetic Management ◽  
Peripartum Cardiomyopathy ◽  
Noninvasive Blood Pressure ◽  
Emergency Cesarean Section ◽  
Emergency Cesarean

We report a case of 28 year old female presenting for an emergency cesarean section with an established diagnosis of peripartum cardiomopathy. Surgery was successfully accomplished under epidural anaesthesia using 15 ml. of 0.5% Bupivacaine, administered in increments. Patient was monitored intra-operatively with Noninvasive blood pressure, pulse oximetry and continuous ECG. Patient's peri-operative course was uneventful. Therefore, it is concluded that in patients with peripartum cardiomyopathy, coming for cesarean section, epidural anaesthesia administered in increments is a safe, acceptable and a better anaesthetic option. JMS 2012;15(1):69-71.

scholarly journals Performance of the AM-5600 blood pressure monitor: comparison with ambulatory intra-arterial pressure

1997 ◽  
Vol 82 (2) ◽  
pp. 698-703 ◽  
Author(s):  
Stefano Omboni ◽  
Gianfranco Parati ◽  
Antonella Groppelli ◽  
Luisa Ulian ◽  
Giuseppe Mancia
Keyword(s):  
Blood Pressure ◽  
Arterial Pressure ◽  
Accurate Estimate ◽  
Blood Pressure Monitor ◽  
Noninvasive Blood Pressure ◽  
Pressure Monitor ◽  
New Device ◽  
Clinical Events ◽  
Electrocardiogram Ecg ◽  
Korotkoff Sounds

Omboni, Stefano, Gianfranco Parati, Antonella Groppelli, Luisa Ulian, and Giuseppe Mancia. Performance of the AM-5600 blood pressure monitor: comparison with ambulatory intra-arterial pressure. J. Appl. Physiol. 82(2): 698–703, 1997.—The AM-5600 is a new device that simultaneously monitors electrocardiogram (ECG) and noninvasive blood pressure (BP) over a 24-h period. BP readings (Korotkoff sounds and cuff air pressure) are stored into the recorder, allowing the removal of BP artifacts after a visual check. In 12 subjects with essential hypertension, we compared BP values simultaneously provided by the AM-5600 and intra-arterial recordings. At rest, noninvasive systolic BP (SBP) values were lower (5.4 ± 4.9 mmHg) and diastolic BP (DBP) values were higher (7.3 ± 7.3 mmHg) than were intra-arterial values. In ambulatory conditions (9 subjects), between-method discrepancies were +0.8 ± 6.1 and +12.2 ± 7.4 mmHg for 24-h SBP and DBP, respectively. AM-5600 underestimated 24-h intra-arterial SBP and DBP SD, but it accurately tracked intra-arterial SBP and DBP changes. Editing removed 22.1% of total readings, slightly reducing between-method discrepancies. Thus the AM-5600 provides an accurate average estimate of resting and ambulatory SBP and, for DBP, a less accurate estimate that is slightly improved by editing. The AM-5600 allows accurate description of SBP and DBP profiles and thus may be suitable to describe the abrupt BP changes accompanying a number of clinical events.

scholarly journals Differential effects of the blood pressure state on pulse rate variability and heart rate variability in critically ill patients

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Elisa Mejía-Mejía ◽  
James M. May ◽  
Mohamed Elgendi ◽  
Panayiotis A. Kyriacou
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Pulse Rate ◽  
Pulse Transit Time ◽  
Pulse Rate Variability ◽  
Physiological Factors ◽  
Ecg Signals ◽  
Non Invasive ◽  
Electrocardiogram Ecg

AbstractHeart rate variability (HRV) utilizes the electrocardiogram (ECG) and has been widely studied as a non-invasive indicator of cardiac autonomic activity. Pulse rate variability (PRV) utilizes photoplethysmography (PPG) and recently has been used as a surrogate for HRV. Several studies have found that PRV is not entirely valid as an estimation of HRV and that several physiological factors, including the pulse transit time (PTT) and blood pressure (BP) changes, may affect PRV differently than HRV. This study aimed to assess the relationship between PRV and HRV under different BP states: hypotension, normotension, and hypertension. Using the MIMIC III database, 5 min segments of PPG and ECG signals were used to extract PRV and HRV, respectively. Several time-domain, frequency-domain, and nonlinear indices were obtained from these signals. Bland–Altman analysis, correlation analysis, and Friedman rank sum tests were used to compare HRV and PRV in each state, and PRV and HRV indices were compared among BP states using Kruskal–Wallis tests. The findings indicated that there were differences between PRV and HRV, especially in short-term and nonlinear indices, and although PRV and HRV were altered in a similar manner when there was a change in BP, PRV seemed to be more sensitive to these changes.

scholarly journals Opioid-Induced Respiratory Depression in Pediatric Palliative Care Patients with Severe Neurological Impairment—A Scoping Literature Review and Case Reports

Children ◽  
2020 ◽  
Vol 7 (12) ◽  
pp. 312
Author(s):  
Maximilian David Mauritz ◽  
Carola Hasan ◽  
Larissa Alice Dreier ◽  
Pia Schmidt ◽  
Boris Zernikow
Keyword(s):  
Risk Factors ◽  
Palliative Care ◽  
Young Adults ◽  
Scoping Review ◽  
Pediatric Patients ◽  
Case Reports ◽  
Neurological Impairment ◽  
Opioid Therapy ◽  
Pediatric Palliative Care ◽  
Severe Neurological Impairment

Pediatric Palliative Care (PPC) addresses children, adolescents, and young adults with a broad spectrum of underlying diseases. A substantial proportion of these patients have irreversible conditions accompanied by Severe Neurological Impairment (SNI). For the treatment of pain and dyspnea, strong opioids are widely used in PPC. Nonetheless, there is considerable uncertainty regarding the opioid-related side effects in pediatric patients with SNI, particularly concerning Opioid-Induced Respiratory Depression (OIRD). Research on pain and OIRD in pediatric patients with SNI is limited. Using scoping review methodology, we performed a systematic literature search for OIRD in pediatric patients with SNI. Out of n = 521 identified articles, n = 6 studies were included in the review. Most studies examined the effects of short-term intravenous opioid therapy. The incidence of OIRD varied between 0.13% and 4.6%; besides SNI, comorbidities, and polypharmacy were the most relevant risk factors. Additionally, three clinical cases of OIRD in PPC patients receiving oral or transdermal opioids are presented and discussed. The case reports indicate that the risk factors identified in the scoping review also apply to adolescents and young adults with SNI receiving low-dose oral or transdermal opioid therapy. However, the risk of OIRD should never be a barrier to adequate symptom relief. We recommend careful consideration and systematic observation of opioid therapy in this population of patients.

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