Undiagnosed catecholamine-secreting paraganglioma and coexisting carcinoid in a patient with MH susceptibility: an unusual anesthetic challenge

Abstract

The management of a patient with two undiagnosed neuroendocrine tumors and possible malignant hyperthermia (MH) susceptibility poses a unique challenge to the anesthesiologist. We describe a total intravenous anesthetic including an alpha 2-agonist infusion combined with epidurally administered bupivacaine for intra- and postoperative pain management. Alpha 2-agonists may offer improved intraoperative hemodynamic management in patients with catecholamine-secreting tumors and reduce the total dose needed for intravenous anesthetics such as propofol. The latter mechanism may be useful to avert the risk of the propofol infusion syndrome occurring as a consequence of a high cumulative dose following its prolonged administration.

Dexmedetomidine as the primary anesthetic agent during cardiac surgery in an infant with a family history of malignant hyperthermia

“…Hudcova and Schumann reported the use of a dexmedetomidine infusion as part of the intraoperative anesthetic care of a 35-year-old woman with a positive family history of MH, during excision of two neuroendocrine tumors. [8] The authors were concerned regarding the potential for the development of the propofol infusion syndrome due to the expected prolonged operative time and the elevated catecholamine levels from the tumor. Dexmedetomidine was used as part of the intraoperative anesthetic care to limit the propofol dose.…”

Experience of significant hemodynamic instability that occurred during excisional biopsy in a patient with unrecognized bronchial carcinoid tumor

“…If accurate diagnosis of a carcinoid tumor is made before an operation, and appropriate medical treatment is given, anesthetic management may improve [2]. However, patients without symptoms may not receive a diagnosis for the disease.…”

“…However, patients without symptoms may not receive a diagnosis for the disease. As a result, patients who are not properly diagnosed could experience a life-threatening event such as carcinoid crisis in response to the anesthesia and surgery they are given [2]. We present a patient who experienced significant hemodynamic instability during excisional biopsy of a solitary pulmonary nodule suspected to be lung cancer.…”