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Different intraoperative decisions for undiagnosed paraganglioma:Two case reports

World Journal of Clinical Cases 2022年第30期10卷 11059-11065页

作者： Dongho Kang Bo-eun Kim Minjae Hong Joungmin Kim seongtae jeong Seongheon Lee Department of Anesthesiology and Pain Medicine Chonnam National University Medical SchoolChonnam National University HospitalGwangju 61469South Korea

BACKGROUND Paragangliomas may be preoperatively misdiagnosed as non-functioning retroperitoneal tumors and are sometimes suspected only at the time of intraoperative *** preoperative alpha blockade preparation,a hypertensive crisis during tumor manipulation and hypotension after tumor removal may result in critical ***,primary consideration should be given to the continuation or discontinuation of surgery on the basis of the possibility of gentle surgical manipulation and hemodynamic *** report two cases of paragangliomas detected *** SUMMARY A 65-year-woman underwent laparoscopic small-bowel wedge resection.A hypertensive crisis occurred during manipulation of the mass,and an unrecognized catecholamine-producing paraganglioma was *** surgeon and anesthesiologists believed that tumor excision could be performed with minimal manipulation of the tumor because the tumor was in a favorable *** hemodynamic instability did not occur with aggressive use of vasoactive drugs.A week later,a 54-year-man underwent open resection of a 3-cm-sized retroperitoneal mass and showed the same findings during mass *** this patient,continuous manipulation of the mass seemed inevitable due to adhesion between the right adrenal gland and the mass in a narrow surgical *** surgeon and anesthesiologists decided to cancel the surgical procedure and planned to perform a reoperation after alpha blockade *** weeks later,the tumor was uneventfully removed with small doses of vasoactive *** When an undiagnosed paraganglioma is suspected intraoperatively,reoperation after adequate preparation should be considered as an option to avoid fatal outcomes.

关键词： Paraganglioma Undiagnosed diseases Hypertensive crisis Preoperative alpha blockade Surgery cancellation Neuroendocrine tumors Case report

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World Journal of Clinical Cases 2020年第21期8卷 5341-5346页

作者： Eun-A Jang Tae-Young Kim Eu-Gene Jung seongtae jeong Hong-Beom Bae Seongheon Lee Department of Anesthesiology and Pain Medicine Chonnam National University Medical SchoolChonnam National University HospitalGwangju 61469South Korea

BACKGROUND Donepezil is an acetylcholinesterase inhibitor used to improve cognition and delay disease progression in dementia patients by increasing acetylcholine *** drug may potentially interact with neuromuscular blocking agents(NMBAs)that act on muscular acetylcholine receptors during general ***,we present a case of inadequate neuromuscular blockade with rocuronium,a nondepolarizing NMBA,in a dementia patient who had taken *** SUMMARY A 71-year-old man was scheduled for laparoscopic *** had been taking donepezil 5 mg for *** anesthesia was induced with propofol and *** depth of neuromuscular blockade was monitored by train-of-four(TOF)*** the administration of rocuronium,the TOF ratio decreased at an unusually slow rate,and a TOF count of 0 was detected 7 min *** intubation,a TOF count of 1 was detected within 1 min,and a TOF ratio of 12%was detected within 2 *** TOF count remained at 4 even with an additional bolus and continuous infusion of rocuronium,suggesting resistance to this *** of propofol,an inhalation anesthetic was administered alongside another NMBA(cisatracurium).Then,the quality of neuromuscular blockade improved,and the TOF count remained at 0-1 for the next 70 *** further problems were encountered with respect to surgery or *** Donepezil may be responsible for inadequate neuromuscular blockade during anesthesia,especially when total intravenous anesthesia is used.

关键词： Donepezil Dementia General anesthesia Rocuronium Neuromuscular blocking agents Case report

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