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114 Pheochromocytoma and C-section – is regional anaesthesia the solution for this dangerous combination?
  1. LA Montenegro Ledo,
  2. TR Alves Martins,
  3. AR Santos Almeida Silva,
  4. MP Sanches Lucas and
  5. EC Pereira
  1. Hospital Garcia de Orta, Almada, Portugal


Background and Aims Pheochromocytoma is a rare cause of hypertension during pregnancy, but it is one of the most threatening medical conditions for mother and fetus. Anaesthetic management for C-section is challenging because it is associated with serious cardiovascular complications.

We report a successful case of c-section under combined spinal-epidural (CSE) anaesthesia in a pregnant patient with a pheocromocytoma.

Methods A 32 weeks pregnant women was referred to our hospital with persistently uncontrolled hypertension. During investigation, an abdominal MRI revealed a right-sided suprarenal mass suggesting a pheochromocytoma. Plasma and urine metanephrines were increased, confirming the diagnosis. The remain study showed normal results.

At a multidisciplinary consultation was decided to do surgical resection of pheochromocytoma after elective C-section at 36th week.

Preoperative medical preparation included α-blockade (doxazocin), beta-blockade (propranolol) and normalization of intravascular volume (high sodium diet).

Results Before induction, a central vein and artery were cannulated for hemodynamic monitoring.

A CSE anaesthesia was performed to minimize hypertensive crises. At subarachnoid space, it was administered 11 mg of hyperbaric bupivacaine and 3 mcg of sufentanyl. Rapid co-filling with 1 l of ringer lactate, under pressure, was administer. Adequate anaesthesia level was guaranteed and patient remained hemodynamically stable, without need of vasoactive drugs. No intercurrences were recorded.

Multimodal analgesia was prescribed for post-operative period with epidural patient control analgesia.

Conclusions Meticulous anaesthetic management is crucial and the choice of anaesthetic technique plays a decisive role in outcome of patient.

Regional anaesthesia presented as an effective technique either in blunt surgical stress and to provide post-operative analgesia.

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