Sekiguchi Shunya, Nakazawa Koichi, Ishida Yusuke, Uchino Hiroyuki
Department of Anesthesiology, Tokyo Medical University, Tokyo, Japan.
SAGE Open Med Case Rep. 2023 Jul 8;11:2050313X231183881. doi: 10.1177/2050313X231183881. eCollection 2023.
We report the anesthetic management of a case of paraganglioma, which was challenging because of intraoperative circulatory changes and difficult ventilatory management. A 52-year-old man with a history of chronic obstructive pulmonary disease was scheduled for paraganglioma resection under general anesthesia combined with epidural anesthesia. Since a marked increase in blood pressure was observed immediately after administration of rocuronium, antihypertensive agents were administered as necessary. The ventilatory settings were initially adjusted to deliver a tidal volume of 7 mL/kg, and the drive pressure was maintained at 13 cm HO or less. However, despite increasing the minute volume, PETCO increased to 60 mmHg and PaCO to 76 mmHg before tumor removal. Blood pressure decreased immediately after tumor removal, and PETCO and PaCO gradually returned to normal. We speculated that the increases in PETCO and PaCO might have been due to both an increase in endogenous catecholamine secretion as well as chronic obstructive pulmonary disease. It is important to preoperatively evaluate the functionality of the tumor and to anticipate perioperative cardiorespiratory instability in the management of paragangliomas.
我们报告了一例副神经节瘤的麻醉管理情况，该病例具有挑战性，原因在于术中循环变化以及通气管理困难。一名有慢性阻塞性肺疾病病史的52岁男性计划在全身麻醉联合硬膜外麻醉下进行副神经节瘤切除术。由于在给予罗库溴铵后立即观察到血压显著升高，必要时给予了抗高血压药物。通气设置最初调整为潮气量7 mL/kg，并将驱动压维持在13 cm HO或更低。然而，尽管增加了分钟通气量，但在肿瘤切除前，呼气末二氧化碳分压（PETCO）升至60 mmHg，动脉血二氧化碳分压（PaCO）升至76 mmHg。肿瘤切除后血压立即下降，PETCO和PaCO逐渐恢复正常。我们推测PETCO和PaCO的升高可能是由于内源性儿茶酚胺分泌增加以及慢性阻塞性肺疾病共同导致的。在副神经节瘤的管理中，术前评估肿瘤功能并预测围手术期心肺不稳定情况很重要。
