Anaesthetic challenges in surgical excision of phaeochromocytoma

Background: Phaeochromocytoma is a rare tumour; which is benign but metabolically active; with a potential for malignancy. This tumour of adrenal or extra adrenal origin usually presents as hypertension; which can be sustained or paroxysmal and with lethal complications. Aim: To present an anaesthetic experience during the surgical resection of a phaeochromocytoma. Method: A 26-year old woman with phaeochromocytoma of the right adrenal gland is presented. The tumour was excised under general anaesthesia. The anaesthesia involved the use of continuous infusion of esmolol (an ultra short-acting intravenous cardioselective beta-antagonist) and propofol. The resected tumour was sent for histopathological examination. Results: The tumour was completely excised under general anaesthesia. The haemodynamic changes that occurred during tumour handling were controlled with fentany1;propofol/esmolol infusion. Histopathological findings confirmed phaeochromocytoma. Conclusion: Although; the anaesthetic and surgical management of a phaeochromocytoma could be an uphill task; it is possible in an environment with limit laboratory and intensive care facilities

Incidence of sickle cell-related sequelae in 60 patients with sickle cell disease following uneventful anaesthesia and surgery: a follow-up study - abstract

The precise relationship between the complications of sickle-cell disease and clinically uneventful anaesthesia and surgery is not clear. Patients with sickle-cell disease are susceptible to certain well-known complications such as infection or sickle-cell crises. The incidence of such sickle-cell-related complications (SCRC's) and their association with procedures requiring anaesthesia was carefully observed in 60 patients during all hospital admissions over the period July, 1978 to October, 1983. Fifty-five (SS) and 5 (SC) patients underwent surgical or major diagnostic procedures under anaesthesia. There were no intraoperative complications or deaths related to anaesthesia. There was on surgically related death due to concealed haemorrhage, and one death on the 8th postoperative day after open-heart surgery due to primary cardiac disease. Of the remaining 58 patients, 3 who underwent 5 procedures under anaesthesia, had no SCR's either before or after operation, or during the period of the study. Fifty-five patients suffered 89 SCRC's unrelated to anaesthesia and surgery. Three had 5 SCRC's related to pregnancy. Thirty-two had 43 SCRC's in the immediate preoperative period, none intraoperatively, and 19 suffered 33 SCRC's in the postoperative period. Twenty-one of 40 patients (53 percent) transfused had postoperative SCRC's and 12 out of 20 (60 per cent) of these were not transfused. The lower incidence of SCRC's in the postoperative period over that in the immediate preoperative period, or in circumstances unrelated to anaesthesia and surgery, suggests that any relationship between SCRC's and uneventful anaesthesia may be one of chance or may reflect individual patient susceptibility to SCRC's (AU)