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Transient severe haemodynamic disturbance during radical nephrectomy: a probable catecholamine surge
Sripriya Ramalingam1, Parthasarathy Srinivasan2
1Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry, Puducherry, India.
BMJ Case Reports
|April 10, 2024
Summary
Electrocauterizing the upper kidney pole during surgery can accidentally stimulate the adrenal gland, causing a temporary surge in blood pressure and a dangerous drop in heart rate. Careful monitoring is crucial to prevent complications.
Area of Science:
- Urology
- Endocrinology
- Anesthesiology
Background:
- Pheochromocytoma and functioning adrenal tumors typically cause catecholamine surges and hemodynamic instability during surgery.
- Radical nephrectomy for renal cell carcinoma is a standard surgical procedure.
Observation:
- During a radical nephrectomy, electrocauterization of the upper kidney pole unexpectedly caused a hypertensive crisis (180/110 mm Hg) and severe bradycardia (35-38 bpm).
- The patient was a male in his 50s with no prior comorbidities.
Findings:
- The episode suggests accidental cauterization of the adrenal gland, leading to a transient catecholamine surge and reflex bradycardia.
- The patient's blood pressure normalized within 30-45 seconds after halting surgical manipulation.
Implications:
- Vigilant monitoring during upper pole kidney electrocauterization is essential.
- Invasive blood pressure monitoring aids in detecting such events.
- Atropine treatment for bradycardia in this context could worsen outcomes by exacerbating catecholamine effects and inducing tachyarrhythmias.
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