No abstract

Phaeochromocytoma has been reported to occur in 0.32070 of hypertensive patients with less than 5% of cases occurring in children. A five-year-old Indian boy weighing 12 kg was admitted with a blood pressure of 240/150 mmHg, and a heart which was clinically enlarged. There were no other signs of hypertension. A chest X-ray showed cardiomegaly, the ECG demonstrating left ventricular hypertrophy. Treatment was started with hydrallazine 2.5 mg q.d.s. and propranolol 20 mg t.d.s., changing to labetolol 50 mg b.d. These doses were increased to hydrallazine 7.5 mg t.d.s., and labetololl00 mg b.d. However, paroxysms of hypertension still occurred, which were treated with injections of diazoxide 60 mg. The urinary catecholamine metabolite levels were found to be elevated and a provisional diagnosis of phaeochromocytoma was made. Phenoxybenzamine 2.5 mg b.d. was added to his medication, and increased over a week to 25 mg b.d., while the other anti-hypertensive drugs were reduced. Because of persistent tachycardia he was given propranolol 20 mg b.d., increasing to 40 mg b.d. His blood pressure was now controlled and the paroxysms of hypertension reduced. His haemoglobin was 13 gldl and potassium 3.0-3.5 mEql1 throughout this period. His first anaesthetic was for an aortic angiogram. No premedication was given. Anaesthesia was induced with sodium thiopentone 50 mg and alcuronium 3 mg. He was ventilated by hand using a mask and 33%