Caesarean section in a patient with Cushing’s syndrome

Glassford, James; Eagle, Christopher; McMorland, G. H.

doi:10.1007/bf03015423

Cited by 14 publications

(8 citation statements)

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“…Glassford et al described severe hypertension during tracheal intubation leading to pulmonary edema in a pregnant woman with Cushing's syndrome [4]. In this case, the blood pressure rose to 190/110 mmHg from 160/70 mmHg during emergence from anesthesia.…”

Section: Discussionmentioning

confidence: 94%

“…Only a few papers have described anesthetic considerations in a pregnant woman with Cushing's syndrome [4][5][6]. Glassford et al described a variety of clinical and technical difficulties for the anesthetist, which include control of airway and prevention of aspiration, postoperative respiratory insufficiency as a result of decreased respiratory muscle mass, hypertension, electrolyte abnormalities, and hyperglycemia [4].…”

Section: Discussionmentioning

confidence: 99%

“…Glassford et al described a variety of clinical and technical difficulties for the anesthetist, which include control of airway and prevention of aspiration, postoperative respiratory insufficiency as a result of decreased respiratory muscle mass, hypertension, electrolyte abnormalities, and hyperglycemia [4]. However, no paper emphasized the importance of anesthetic management for preventing pulmonary edema during operation.…”

Section: Discussionmentioning

confidence: 99%

“…Excess glucocorticoids suppress gonadotropin secretion, resulting in amenorrhea or oligomenorrhea in 75% of premenopausal women with Cushing's syndrome [1]. For these reasons, only 63 pregnancies were reported in women with Cushing's syndrome up to 1990 and 69 cases up to 1994 [2,3], and only a few papers describe anesthetic considerations for a pregnant woman with Cushing's syndrome [4][5][6]. Once patients become pregnant, however, various complications occur, including persistent hypertension, hyperglycemia, and pulmonary edema [2,5,7].…”

Section: Introductionmentioning

confidence: 97%

See 3 more Smart Citations

Pulmonary edema after laparoscopic adrenalectomy in a pregnant patient with Cushing's syndrome

Nakashima

Itonaga

Inoue

et al. 2000

Journal of Anesthesia

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crinological studies were performed. Laboratory studies revealed abnormally high levels of serum cortisol (58.6 µg·dl Ϫ1 ), urinary 17-OHCS (18 mg·day Ϫ1 ), and urinary cortisol (1860 µg·day Ϫ1 ) and a low level of ACTH (5.5 pg·ml Ϫ1 ). Furthermore, MRI revealed a left adrenal tumor 3 cm in diameter. Cushing's syndrome was diagnosed from these data at 28 weeks of gestation. Arterial hypoxia was not observed (PaO 2 ϭ 96 mmHg, FiO 2 ϭ 0.21). Because the hypertension could not be controlled by medications (α-methyldopa and furosemide), she was scheduled for laparoscopic adrenalectomy at 31 weeks of gestation. She was premedicated with diazepam (5 mg, p.o.) and famotidine (20 mg, p.o.) 4 h before anesthesia. In the operating room, an epidural catheter was placed 5 cm cephalad via the T9-10 interspace with a Tuohy needle (17 G) using the saline loss of resistance technique in the lateral position. As a test dose, 3 ml of 2% mepivacaine was injected through the epidural catheter, and no hypesthesia was observed after 10 min of injection. An additional 10 ml of 2% mepivacaine was injected, and the hypesthesia level was obtained from T4 to T11 after 10 min of injection. Before induction, the blood pressure was 180/100 mmHg. Anesthesia was induced with 175 mg thiamylal and 0.1 mg fentanyl with cricoid pressure. The patient was intubated easily with 6 mg vecuronium. After intubation, the blood pressure was 168/92 mmHg, and no secretion could be aspirated through the endotracheal tube. Anesthesia was maintained with sevoflurane (1%-3%) and epidural infusion of 2% mepivacaine (5 ml·h Ϫ1 ). She was placed in the flexed lateral position and underwent laparoscopic adrenalectomy. The intraperitoneal pressure during laparoscopy was less than 10 mmHg. The blood pressure was almost stable (130-170/80-100 mmHg) before isolation of the adrenal gland and changed dynamically (85-190/55-100 mmHg) during isolation of the tumor. The total operating time was two and a half hours. Pathohistological study revealed that the adrenal tumor was an adenoma. During emer-

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%