TYK321
Which is not anticipated in the perioperative period for pheochromocytoma resection?
a) Bradycardia
b) Hypertension
c) Hypotension
d) Tachycardia
e) Hypoglycemia
Answer
Answer a. Induction, laryngoscopy and tumor manipulation all may cause severe sustained hypertension. A deepened plane of anesthesia and placement of an epidural catheter may attenuate hypertension from sympathetic stimulus, but the direct catecholamine release from tumor manipulation may require infusion of short-acting vasodilating agents (nitroprusside, nicardipine, magnesium sulfate) and beta-blockade (esmolol). Phentolamine (IV alpha-blockade) has a longer half-life (19 minutes) but may be useful prior to tumor resection. Once the tumor’s venous drainage is obliterated, unopposed vasodilation (and reflex tachycardia) may result. Hypovolemic hypotension may require fluid resuscitation and use of vasoconstricting agents (phenylephrine, norepinephrine or vasopressin). Relief of epinephrine secretion may lead to hyperinsulinemia and subsequent hypoglycemia. Bradycardia would be unexpected unless as an iatrogenic complication of therapy.
Notes
- This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.