Abstract | RATIONALE: PATIENT CONCERNS: A 36-year-old man was admitted with a left retroperitoneal space-occupying lesion, present for 2 years. The patient also had DCM for 2 years. Blood analysis on admission showed elevated levels of norepinephrine and the N-terminus of the brain natriuretic peptide precursor. Abdominal computed tomography revealed a circular shadow in the left adrenal area. Echocardiography showed a cardiac ejection fraction of 31% to 37%, markedly enlarged left atrium and left ventricle, extensive cardiac hypokinesia, and reduced left ventricular diastolic and systolic functions. DIAGNOSES: INTERVENTIONS: Multidisciplinary consultation, blood pressure measurements, and volume expansion measurements were performed preoperatively. Invasive arterial blood pressure, central venous pressure, depth of anesthesia, cardiac function, left heart volume, and body temperature were monitored intraoperatively. OUTCOMES: The adrenal pheochromocytoma was successfully removed, and the patient recovered well. LESSONS: The anesthetic management for adrenal pheochromocytoma resection in adult patients with DCM is extremely high-risk but is evidently not impossible. Adequate preoperative evaluation and preparation, optimization of the anesthesia induction plan, close intraoperative monitoring of cardiac function and hemodynamic changes, and robot-assisted laparoscopic technology are the key success factors. The challenges to anesthetic management may be partly prevented with invasive monitoring techniques and minimally invasive surgery. This case confirms the importance of individual management and multidisciplinary cooperation for a successful outcome.
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Authors | Long Huang, Jiarui Wu, Baorong Lian, Daxue Zhang, Yujia Zhai, Liming Cao |
Journal | Medicine
(Medicine (Baltimore))
Vol. 102
Issue 41
Pg. e35467
(Oct 13 2023)
ISSN: 1536-5964 [Electronic] United States |
PMID | 37832053
(Publication Type: Case Reports, Journal Article)
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Copyright | Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc. |
Chemical References |
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Topics |
- Male
- Adult
- Humans
- Cardiomyopathy, Dilated
(complications, surgery)
- Pheochromocytoma
(complications, surgery)
- Robotics
- Adrenal Gland Neoplasms
(complications, surgery)
- Anesthesia
(methods)
- Laparoscopy
- Anesthetics
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