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Case Report

Anasthetic Management of a Case of Unilateral Adrenal Mass in Young Female for Adrenalectomy

Heena Parikh , Heena Parikh , Malini Mehta

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Indian Journal of Anesthesia and Analgesia 1(1):p 27-32, January - June 2014. | DOI:

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Abstract

Pheochromocytoma, tumours originating from chromaffin tissue and typically occurs in patients of 30-50 years of age, commonly present with symptoms and signs of catecholamine excess. A 22 year old female patient presented with right sided flank pain, palpitation and occasional giddiness scheduled for right adrenalectomy. Diagnosis was confirmed by CT scan abdomen and post operatively by histopathological examination.

Preoperatively patient’s blood pressure was normal. Here we discuss her intraoperative management and post operative course in anaesthesia room as well as in surgical ICU, especially pulmonary oedema that occurred within 2 hours after resection. (Half life of cortisol is 80-110 minutes.)The anesthetic  technique used was combined general and regional anaesthesia with control of blood pressure during operation and manipulation of tumor with nitroglycerine infusion.Post-operative concerns included acute adrenal insufficiency and pulmonary oedema which were successfully managed in anaesthesia room and surgical ICU.Epidural analgesia was used for post-operative pain relief.One month later she was reassessed and was symptom free.

Keywords: Pheochromocytoma (adrenalectomy); Hypertension; Anaesthetic management; Pulmonary oedema.

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