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KMID : 0356019940090010091
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Koean Jounral of Critical Care Medicine
1994 Volume.9 No. 1 p.91 ~ p.96
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Anesthesia for Undiagnosed Paraganglioma
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Abstract
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A 36-year-old male with a transitional cell carcinoma of bladder was scheduled for radical cystectomy. After premedication with diazepam and atropine, continuous lumbar epidural anesthesia was performed for postoperative pain control. Severe unexplained hypertension and tachycardia (BP;210/l30 mmHg, HR: l53/min) were developed during induction, Continuous epidural block with deep inhalation anesthesia and intravenous administration of nitroglycerin and verapamil could not stabilize the vital sign. During bladder dissection, intractable hypertension and tachycardia were more aggrevated inspite of administration of nitroprusside. Epidural injection of 0.5% bupivacaine 20 ml combined with intravenous infusion of nitroprusside seemed to decrease the hypertension and tachycardia.
After removal of bladder and tumor, blood pressure decreased rapidly to 75/50mmHg but tachycardia was continued. Hypotension was controlled with rapid transfusion of blood and in- fusion of dopamine and ephedrine to the end of operation. On the postoperative pathological report, paraganglioma has been combined with the transitional cell carcinoma of bladder.
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