Korean J Anesthesiol.  2001 Jan;40(1):106-110. 10.4097/kjae.2001.40.1.106.

Paroxysmal Hypertension during Cardiopulmonary Bypass in a Patient with Pheochromocytoma Undergoing Coronary Artery Bypass Grafting

• Oh YJ
• Kim EK
• Lee CS
• Kang WC
• Kwak YL
• Hong YW

• KMID: 2298979
• DOI: http://doi.org/10.4097/kjae.2001.40.1.106

Abstract

A 39 year old man suffering from pheochromocytoma and coronay artery obstruction diseases was scheduled for coronary artery bypass graft surgery before an adrenalectomy. General anesthesia was induced with fentanyl and midazolam and maintained with intermittent administration of fentanyl and low concentraion of isoflurane. At 5 minutes after commencement of cardiopulmonary bypass (CPB), the mean arterial pressure suddenly elevated to 150 mmHg. Sodium nitroprusside and labetalol were administered rapidly, however, mean arterial pressure could not be lowered below 100 mmHg. After release of aortic cross clamp, the electrocardiography showed tachycardia (150 beats/min) with wide QRS and systolic arterial pressure elevated to 180 mmHg. Antiarrhythmic drugs, inotropic and antiischemic drugs were administered. Thereafter tachycardia was disappeared and systolic arterial pressure was lowered below 150 mmHg. We observed the paroxysmal hypertension and tachycardia during CPB that is considered to be attributed to the presence of pheochromocytoma. Therefore we suggest that continuous thoracic epidural anesthesia and pulsatile perfusion during CPB could be helpful in a patient with pheochromocytoma undergoing coronary artery bypass grafting.

Keyword

Blood pressure: hypertension; Heart: cardiopulmonary bypass; Hormones: adrenal; catecholamine; pheochromocytoma

MeSH Terms

Adrenalectomy
Adult
Anesthesia, Epidural
Anesthesia, General
Anti-Arrhythmia Agents
Arterial Pressure
Arteries
Cardiopulmonary Bypass*
Coronary Artery Bypass*
Coronary Vessels*
Electrocardiography
Fentanyl
Humans
Hypertension*
Isoflurane
Labetalol
Midazolam
Nitroprusside
Pheochromocytoma*
Pulsatile Flow
Tachycardia
Transplants
Anti-Arrhythmia Agents
Fentanyl
Isoflurane
Labetalol
Midazolam
Nitroprusside