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Transient severe haemodynamic disturbance during radical nephrectomy: a probable catecholamine surge
  1. Sripriya Ramalingam and
  2. Parthasarathy Srinivasan
  1. Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry, Puducherry, India
  1. Correspondence to Dr Parthasarathy Srinivasan; painfreepartha{at}gmail.com

Abstract

Catecholamine surge and haemodynamic derangements are normally expected during the surgery for pheochromocytoma and benign functioning adrenal tumours. This male patient in his 50s underwent radical nephrectomy for renal cell carcinoma. The patient had no comorbidities. Three hours into the surgery, during electrocauterisation of the upper pole of the kidney, the patient’s blood pressure unexpectedly spiked to 180/110 mm Hg, which was immediately followed by a decrease in heart rate to 35–38 beats/min. The surgeons were instructed to briefly halt the surgical manipulation. The blood pressure returned to the pre-surge level within 30–45 s. The surgery was completed without further complications, and the patient had an uneventful recovery. The episode is suggestive of the probability that the electrocauterisation of the upper pole of the kidney led to the accidental cauterisation of the adrenal gland, resulting in a transient catecholamine surge, increase in blood pressure and reflex bradycardia suggesting norepinephrine release. Treating bradycardia with atropine in such situations can exacerbate the effects of catecholamines and lead to dangerous tachyarrhythmias. The case report highlights the importance of vigilant monitoring during electrocauterisation of the upper pole of the kidney, invasive arterial blood pressure monitoring in detecting and recording such occurrences and cautiously selecting a treatment plan.

  • Anaesthesia
  • Urological surgery

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Footnotes

  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigations results, drawing original diagrams and algorithms, and critical revision of the intellectual content—SR and PS. The following authors gave final approval of the manuscript—SR and PS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.