Tumour lysis syndrome during anaesthesia

Abstract

We describe a child who developed acidosis, hyperkalaemia and cyanosis while emerging from an otherwise uneventful anaesthetic. A diagnosis of tumour lysis syndrome was suspected and confirmed biochemically. Although this syndrome is usually associated with chemotherapy and has been described to occur spontaneously, it has not previously been reported as being associated with anaesthesia.

Anesthesia Case of the Month

“…9 Immunotherapy, chemotherapy, radiation therapy, and corticosteroid administration can precipitate acute tumor lysis syndrome, [15][16][17][18] although none of these were a factor in the dog described in the present report, other than administration of prednisolone prescribed by the referring veterinarian to treat swelling of the tarsal joint. 19 With acute tumor lysis syndrome, intracellular contents, such as phosphorus, potassium, and purines, are released into the systemic circulation as tumor cells are destroyed. 19 With acute tumor lysis syndrome, intracellular contents, such as phosphorus, potassium, and purines, are released into the systemic circulation as tumor cells are destroyed.…”

“…19 With acute tumor lysis syndrome, intracellular contents, such as phosphorus, potassium, and purines, are released into the systemic circulation as tumor cells are destroyed. Phosphate released from lysed cells can combine with calcium to form calcium phosphate, an insoluble compound that may lead to tissue damage and cause renal failure, pruritus, cutaneous gangrene, and inflammation of the eyes or joints, 19 although none of these abnormalities were identified in the dog described in the present report. Although purines in humans are catabolized by the liver through oxidation of xanthine and hypoxanthine to uric acid, 20 in dogs other than English Bulldogs and Dalmatians, uric acid is oxidized to allantoin by uricase, [21][22][23] with the result that most dogs would not be expected to develop hyperuricemia.…”

Fatal peri‐operative acute tumour lysis syndrome precipitated by dexamethasone

“…A previous case report describes the administration of 20 mg dexamethasone to a 42‐year‐old female patient with cervical lymphadenopathy and subsequent development of tumour lysis syndrome [3]. The first published report of tumour lysis syndrome occurring under general anesthesia was published in 2001 and describes acute onset in a 12‐year‐old child after liver transplantation presenting with ascites and ‘massive abdominal lymphadenopathy’ [4]. This child did not receive steroids during the course of surgery and onset of tumour lysis was thought to be due to lysis precipitated by biopsy of the lesion.…”

Tumour lysis syndrome developing during an operation

“…To our knowledge, tumour lysis syndrome has not been reported as occurring during an operation for omental biopsy. However, cases developing tumour lysis syndrome following open or transcutaneous ultrasound‐guided biopsy have been reported [3, 4]. The pathogenesis of tumour lysis syndrome triggered by surgery is unclear.…”