Abstracts / Posters
Anaesthetic Managment Of Patient Of Bilateral Pheochromocytoma With Hypertrophic Obstructive Cardiomyopathy Posted For Bilateral Adrenelectomy
Institute :GMC Nagpur
ABSTRACT : Bilateral pheochromocytoma with HOCM is rare finding, delayed diagnosis and treatment lead to increased complication, presence of these contrast condition together posses a unique problem for anaesthesiologist
METHODS : 26 yr old male diagnosed bilateral pheochromocytoma since 2006 at KEM hospital and 2D echo Suggesting of asymmetric hypertrophy of septum 30.9mm and LVOT 56.9mm,posted for bilateral adrenelectomy in Gmcnagpur. Here we highlight the successful management of this case under general anaesthesia and epidural anaesthesia. Pheocromocytoma itself huge anaesthetic risk which compounded many fold by presence of HOCM. The challenges that we face during induction and clamping of adrenal vein of second tumour is managed by use of IV Esmolol instead of vasodilator IV SNP and IV NTG which worsens HOCM, also sudden hypotension managed with IV Noradrenalin instead of IV Dopamine. Use of epidural anaesthesia is better tolerated by HOCM pt which is beneficial in intraoperative and postoperative pain relief.
RESULTS : This case was succesfully managed under general anaesthesia and epidural anaesthesia
.CONCLUSIONS : In such high risk and complicated cases early involvement of anaesthesiologist and good communications among surgen,physician,cardiologist,endocrinologist and anaesthesiologist ensures better outcome.