A young, physically strong male patient of ASA 1 reported to operating rooms to get removed three of his small lipomas, which were scattered between his anterior abdominal wall and the lateral side of the right thigh. Routine monitors were attached and all his parameters were noted to be within normal limits. General anesthesia (GA) was induced in a routine manner and an LMA was inserted. Inj. pethidine was used to provide analgesia. Everything seemed to be going smooth as planned. The procedure was a short one and there was no hurry. The surgical excision was underway, when about 10 minutes after the induction of GA, the cardiac monitor sounded alarm. A reading showed high BP. The reading was repeated without change. Assuming inadequate analgesia, a second dose of inj. pethidine was given and the depth of anesthesia was increased. After a few minutes BP was measured by the manual (stat) method. It was even still higher. The circuit and the endotracheal tube were rechecked and no fault was detected. The cause of his hypertension could not be found. Just then the surgeon informed that he had finished the surgery. The gases were turned off and 100% oxygen was started. A few minutes later, LMA was removed and the patient was shifted to the PACU. It was hoped that with the cessation of the surgical stimulus, his high BP would settle down, but the increased BP failed to get lowered despite all conservative measures. The patient started to desaturate and developed severe tachycardia. Reintubation was done to provide 100% oxygen by mechanical ventilation. Pink frothy fluid filled the tube and had to be suctioned repeatedly. The next reading was recorded at 220/130 mmHg. The patient was transferred to the ICU and ventilated; CT scan was done on an emergent basis while the patient was on ventilator. A small suprarenal mass was found, suspected to be a pheochromocytoma. Relevant investigations were ordered and medical treatment was provided. The next day after being stabilized, the patient was transferred to a better equipped, central referral hospital for surgical removal of his pheochromocytoma. Patient visited us one month later for follow-up in a perfect condition. On inquiring, he still denied having any episode of high BP or related symptoms any time in his life.
The stress of anesthesia and surgery had somehow, provocated a silent tumor in this asymptomatic young man, which precipitated an episode of acute rise of BP and pulmonary edema.
Consultant /HoD Anesthesiology, Oasis Hospital,
United Arab Emirates
