Hypertensive crisis caused by electrocauterization of the adrenal gland during hepatectomy

BMC Surgery

Seonghoon Ko¹  Hee Chul Yu²  Young-Jin Han¹  Ji-Seon Son¹  A Ram Doo¹ 

[1] Department of Anesthesiology and Pain Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea;Department of Surgery and Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea

关键词: Hypertensive crisis;    Hepatectomy;    Electrocautery;    Adrenal gland;   

Others  :  1140458
DOI  :  10.1186/1471-2482-15-11

 received in 2013-08-16, accepted in 2015-01-06,  发布年份 2015

【 摘 要 】

Background

Hypertensive crisis (i.e., systolic blood pressure over 300 mmHg) is very rare during operation except pheochromocytoma, but it can be a fatal and embarrassing to surgeons and anesthesiologists. The right adrenal gland can be electrocauterized during a right hemi-hepatectomy. We report a case of hypertensive crisis during right hemi-hepatectomy in which the right adrenal gland was stimulated by monopolar electrocautery in a patient with normal neuroendocrine function.

Case presentation

A 73-year-old man with hepatocellular carcinoma was scheduled to undergo right hemi-hepatectomy. Three hours into the surgery, the patient’s blood pressure increased abruptly from 100/40 to over 350/130 mmHg (the maximum measurement pressure of the monitor; 350 mmHg). The surgeon had cauterized the right adrenal gland using monopolar electrocautery to separate the liver from the adrenal gland immediately prior to the event. Approximately 3 minutes after suspending the operation, blood pressure returned to baseline levels. After the event, the operation was successfully completed without any complication. Hormonal studies and iodine-123 meta-iodobenzylguanidine scintigraphy revealed no neuroendocrine tumor such as a pheochromocytoma.

Conclusion

Operations such as hepatectomy that stimulate the adrenal gland may lead to an unexpected catecholamine surge and result in hypertensive crisis, even if neuroendocrine function of the adrenal gland is normal.

【 授权许可】

   
2015 Doo et al.; licensee BioMed Central.

【 参考文献 】

• [1]Wajima Z, Inoue T, Yoshikawa T, Imanaga K, Ogawa R: Changes in hemodynamic variables and catecholamine levels after rapid increase in sevoflurane or isoflurane concentration with or without nitrous oxide under endotracheal intubation. J Anesth 2000, 14(4):175-9.
• [2]Komatsu R, Turan AM, Orhan-Sungur M, McGuire J, Radke OC, Apfel CC: Remifentanil for general anaesthesia: a systematic review. Anaesthesia 2007, 62(12):1266-80.
• [3]Vater M, Achola K, Smith G: Catecholamine responses during anaesthesia for phaeochromocytoma. Br J Anaesth 1983, 55(4):357-60.
• [4]Farling PA, Durairaju AK: Remifentanil and anaesthesia for carcinoid syndrome. Br J Anaesth 2004, 92(6):893-5.
• [5]Park JT, Lim HK, Park JH, Lee KH: Thyroid storm during induction of anesthesia. Korean J Anesthesiol 2012, 63(5):477-8.
• [6]Fung MM, Viveros OH, O'Connor DT: Diseases of the adrenal medulla. Acta Physiol (Oxf) 2008, 192(2):325-35.
• [7]Chini EN, Brown MJ, Farrell MA, Charboneau JW: Hypertensive crisis in a patient undergoing percutaneous radiofrequency ablation of an adrenal mass under general anesthesia. Anesth Analg 2004, 99(6):1867-9. table of contents
• [8]Flanigan JS, Vitberg D: Hypertensive emergency and severe hypertension: what to treat, who to treat, and how to treat. Med Clin North Am 2006, 90(3):439-51.
• [9]Paix AD, Runciman WB, Horan BF, Chapman MJ, Currie M: Crisis management during anaesthesia: hypertension. Qual Saf Health Care 2005, 14(3):e12.
• [10]Ito Y, Fujimoto Y, Obara T: The role of epinephrine, norepinephrine, and dopamine in blood pressure disturbances in patients with pheochromocytoma. World J Surg 1992, 16(4):759-63. discussion 763–754
• [11]Lim YH, Rhee WJ, Choi SR, Park SW, Chung CJ: Intraoperative hypertension in a patient with undiagnosed pheochromocytoma under spinal anesthesia. Korean J Anesthesiol 2011, 61(5):439-40.
• [12]Baraka A: Perioperative hemodynamic crisis in undiagnosed pheochromocytoma patient–undergoing incidental surgery. Middle East J Anesthesiol 2012, 21(5):663-4.
• [13]Shinn HK, Jung JK, Park JK, Kim JH, Jung IY, Lee HS: Hypertensive crisis during wide excision of gastrointestinal stromal cell tumor (GIST): Undiagnosed paraganglioma -A case report. Korean J Anesthesiol 2012, 62(3):289-92.
• [14]Onik G, Onik C, Medary I, Berridge DM, Chicks DS, Proctor LT, et al.: Life-threatening hypertensive crises in two patients undergoing hepatic radiofrequency ablation. AJR Am J Roentgenol 2003, 181(2):495-7.
• [15]Barrett SL, Vella JM, Dellon AL: Historical development of bipolar coagulation. Microsurgery 2010, 30(8):667-9.