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Anesthesia for pheochromocytoma resection in a child with Fontan circulation
Thomas R Latendresse1, Adam B Goldin2, Christer Jonmarker3
1Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital and the University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
Insights
Anesthetic management for pheochromocytoma resection in a child with Fontan circulation was successful. Postoperative care required managing residual sympathetic blockade and hypotension.
Area of Science:
- Pediatric Anesthesiology
- Cardiovascular Surgery
- Pediatric Endocrinology
Background:
- A patient with Ivemark syndrome and completed Fontan circulation underwent resection of a norepinephrine-producing pheochromocytoma.
- Preoperative management included oral propranolol and phenoxybenzamine.
Observation:
- The patient was an 11-year-old boy with a history of Fontan palliation.
- A norepinephrine-producing pheochromocytoma was diagnosed six weeks prior to surgery.
Findings:
- Intraoperative hemodynamic control was achieved using magnesium sulfate, esmolol, and phentolamine.
- Postoperative hypotension occurred, necessitating fluid administration and prolonged intensive care.
Implications:
- Successful anesthetic management is crucial for complex pediatric cases involving Fontan circulation and pheochromocytoma.
- Postoperative care must address potential complications like sympathetic blockade and hypotension in these high-risk patients.
Purpose:
To report the anesthetic management of a successful resection of a pheochromocytoma in a child with a completed Fontan circulation.
Clinical Features:
The patient was an 11-yr-old boy with Ivemark syndrome who had undergone Fontan palliation at three years of age. Six weeks earlier, he had been diagnosed with a norepinephrine-producing pheochromocytoma, and he had been pretreated with oral propranolol and phenoxybenzamine. During surgery, intravenous administration of magnesium sulphate, esmolol, and phentolamine provided good hemodynamic control. Postoperatively, the patient tended to be hypotensive, and treatment with fluid administration resulted in prolonged intensive care.
Conclusion:
Although intraoperative management was not problematic, postoperative care of this 11-yr old child with pheochromocytoma was complicated by residual sympathetic blockade.
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