Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry, Puducherry, India.
Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry, Puducherry, India
BMJ Case Rep. 2024 Apr 10;17(4):e257045. doi: 10.1136/bcr-2023-257045.
Catecholamine surge and haemodynamic derangements are normally expected during the surgery for pheochromocytoma and benign functioning adrenal tumours. This male patient in his 50s underwent radical nephrectomy for renal cell carcinoma. The patient had no comorbidities. Three hours into the surgery, during electrocauterisation of the upper pole of the kidney, the patient's blood pressure unexpectedly spiked to 180/110 mm Hg, which was immediately followed by a decrease in heart rate to 35-38 beats/min. The surgeons were instructed to briefly halt the surgical manipulation. The blood pressure returned to the pre-surge level within 30-45 s. The surgery was completed without further complications, and the patient had an uneventful recovery. The episode is suggestive of the probability that the electrocauterisation of the upper pole of the kidney led to the accidental cauterisation of the adrenal gland, resulting in a transient catecholamine surge, increase in blood pressure and reflex bradycardia suggesting norepinephrine release. Treating bradycardia with atropine in such situations can exacerbate the effects of catecholamines and lead to dangerous tachyarrhythmias. The case report highlights the importance of vigilant monitoring during electrocauterisation of the upper pole of the kidney, invasive arterial blood pressure monitoring in detecting and recording such occurrences and cautiously selecting a treatment plan.
儿茶酚胺激增和血液动力学紊乱通常在嗜铬细胞瘤和良性功能性肾上腺肿瘤的手术中出现。这名 50 多岁的男性因肾细胞癌接受根治性肾切除术。该患者没有合并症。手术进行到 3 小时，在上极电灼时，患者的血压意外飙升至 180/110mmHg，随后心率立即降至 35-38 次/分。外科医生被指示短暂停止手术操作。血压在 30-45 秒内恢复到术前水平。手术顺利完成，没有出现其他并发症，患者恢复顺利。该事件提示上极电灼可能意外导致肾上腺电灼，导致短暂儿茶酚胺激增、血压升高和反射性心动过缓，提示去甲肾上腺素释放。在这种情况下，用阿托品治疗心动过缓可能会加剧儿茶酚胺的作用，导致危险的心动过速。该病例报告强调了在上极电灼期间进行警惕监测的重要性，使用有创动脉血压监测来检测和记录此类事件，并谨慎选择治疗方案。
