Korean J Crit Care Med.  2013 Feb;28(1):64-66. 10.4266/kjccm.2013.28.1.64.

Hypertensive Crisis during Removal of Retroperitoneal Mass in a Patient with Undiagnosed Paraganglioma - A Case Report -

• Kim HY
• Kim JY
• Kim HK
• Baek SH

• KMID: 2227914
• DOI: http://doi.org/10.4266/kjccm.2013.28.1.64

Abstract

Paragangliomas have been reported on multiple locations. A diagnosis of a catecholamine-secreting tumor was considered only after induction of anesthesia, when BP (blood pressure) increased. A 61-year-old male patient was referred for removal of a retroperitoneal mass suspected hemangiopericytoma. He was on medications for hypertension. There was a surge of ABP (arterial blood pressure) to 186/117 mmHg when the tumor was manipulated at the beginning of the surgery, and this was treated by bolus of diltiazem. After resection of the tumor, ABP dropped to 57/36 mmHg. In order to improve the patient's hemodynamic parameters, crystalloid fluid was given, and ephedrine was administered intravenously. Persistent hypotension was treated with titrated vasopressors (epinephrine and norepinephrine). When paraganglioma is suspected due to a sudden hypertensive crisis during surgery, the surgeon must decide whether to proceed with the surgical procedure or to stop and restart the surgery after proper management of the crisis.

Keyword

hypertensive crisis; paraganglioma; retroperitoneal mass

MeSH Terms

Anesthesia
Diltiazem
Ephedrine
Hemangiopericytoma
Hemodynamics
Humans
Hypertension
Hypotension
Isotonic Solutions
Male
Paraganglioma
Diltiazem
Ephedrine
Isotonic Solutions