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Korean J Anesthesiol > Volume 40(1); 2001 > Article
Korean Journal of Anesthesiology 2001;40(1):106-110.
DOI: https://doi.org/10.4097/kjae.2001.40.1.106   
Paroxysmal Hypertension during Cardiopulmonary Bypass in a Patient with Pheochromocytoma Undergoing Coronary Artery Bypass Grafting.
Young Jun Oh, Eun Kyoung Kim, Choon Soo Lee, Won Chul Kang, Young Lan Kwak, Yong Woo Hong
1Department of Anesthesiology, Yonsei University College of Medicine, Seoul, Korea.
2Department of Anesthesiology, Inha University College of Medicine, Inchon, Korea.
Abstract
A 39 year old man suffering from pheochromocytoma and coronay artery obstruction diseases was scheduled for coronary artery bypass graft surgery before an adrenalectomy. General anesthesia was induced with fentanyl and midazolam and maintained with intermittent administration of fentanyl and low concentraion of isoflurane. At 5 minutes after commencement of cardiopulmonary bypass (CPB), the mean arterial pressure suddenly elevated to 150 mmHg. Sodium nitroprusside and labetalol were administered rapidly, however, mean arterial pressure could not be lowered below 100 mmHg. After release of aortic cross clamp, the electrocardiography showed tachycardia (150 beats/min) with wide QRS and systolic arterial pressure elevated to 180 mmHg. Antiarrhythmic drugs, inotropic and antiischemic drugs were administered. Thereafter tachycardia was disappeared and systolic arterial pressure was lowered below 150 mmHg. We observed the paroxysmal hypertension and tachycardia during CPB that is considered to be attributed to the presence of pheochromocytoma. Therefore we suggest that continuous thoracic epidural anesthesia and pulsatile perfusion during CPB could be helpful in a patient with pheochromocytoma undergoing coronary artery bypass grafting.
Key Words: Blood pressure: hypertension; Heart: cardiopulmonary bypass; Hormones: adrenal; catecholamine; pheochromocytoma


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