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Liu J, Zurakowski D, Weldon C, Umaretiya P, Holzman R, Lin YC. Perioperative hypertension and anesthetic management in patients undergoing resection of neuroblastoma. Paediatr Anaesth 2023. [PMID: 37052325 DOI: 10.1111/pan.14673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/14/2023] [Accepted: 04/02/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Neuroblastoma is the most common extracranial pediatric tumor, accounting for 5-8% of all childhood cancers. Neuroblastomas arise from catecholamine-secreting neural crest cells and their metabolites, vanillylmandelic acid and homovanillic acid, that are readily detected in urine. Although rarely seen in clinical practice, case reports exist documenting severe intraoperative hypertension. However, data on the incidence of intraoperative hypertension are lacking. METHODS This report is a single-center retrospective review of patients with neuroblastoma who underwent surgical resection (n = 102) at Boston Children's Hospital from July 1, 2012 to February 28, 2021. Significant intraoperative hypertension was defined as maximum systolic blood pressure greater than 95th percentile +12 mmHg based on normative blood pressure data. Statistical analysis was performed using Fisher's exact test, Wilcoxon rank-sum test, and logistic regression. RESULTS The overall incidence of intraoperative hypertension was 13% (n = 13/102). Higher American Society of Anesthesiologists (ASA) physical status was associated with intraoperative hypertension. Antihypertensive medications were administered intraoperatively in 9% of cases (n = 9), and the use was significantly associated with intraoperative hypertension. Of patients with preoperative urine catecholamine data (n = 82), all 10 patients who had intraoperative hypertension were noted to have elevated preoperative urine catecholamines. Intraoperative hypertension was not associated with postoperative hypertension, postoperative hypotension, or increased intensive care unit length of stay. DISCUSSION/CONCLUSION Intraoperative hypertension in patients with neuroblastoma remains a relatively uncommon occurrence; however, it does occur at a frequency higher than previously described. While intraoperative hypertension is associated with an increased use of antihypertensive medications in the operating room, it is not associated with adverse perioperative outcomes.
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Affiliation(s)
- Jia Liu
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher Weldon
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatric Oncology, Children's Cancer and Blood Disorders Center, Dana-Farber Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Puja Umaretiya
- Department of Pediatric Oncology, Children's Cancer and Blood Disorders Center, Dana-Farber Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Holzman
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yuan-Chi Lin
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Vadlapudi SS, Srivastava A, Nishith N, Sarma MS, Poddar U, Pandey R. Spontaneous tumour lysis syndrome at presentation in an infant with hepatoblastoma: A rare occurrence. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2021. [DOI: 10.1016/j.phoj.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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3
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Anesthesia in Children with Neuroblastoma, Perioperative and Operative Management. CHILDREN-BASEL 2021; 8:children8050395. [PMID: 34068896 PMCID: PMC8156024 DOI: 10.3390/children8050395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 01/10/2023]
Abstract
Neuroblastoma (NB) is the most common extracranial, solid, pediatric malignancy and, despite the constant progress of treatment and development of innovative therapies, remains a complex, challenging disease causing major morbidity and mortality in children. There is significant variability in the management of neuroblastoma, partially due to the heterogeneity of the clinical and biological behavior, and partially secondary to the different approaches between treating institutions. Anesthesia takes an integral part in the multidisciplinary care of patients with NB, from diagnosis to surgery and pain control. This paper aims to review and discuss the critical steps of the perioperative and operative management of children undergoing surgery for neuroblastoma. Anesthesia and analgesia largely depend on tumor location, surgical approach, and extension of the surgical dissection. Attention should be paid to the physio-pathological changes on cardiovascular, gastrointestinal, and immune systems induced by the tumor or by chemotherapy. At the time of surgery meticulous patient preparation needs to be carried out to optimize intraoperative monitoring and minimize the risk of complications. The cross-sectional role of anesthesia in cancer care requires effective communication between all members of the multidisciplinary team.
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Rastogi A, Nasar N, Mandelia A, Singh TK. Posterior mediastinal mass in a neonate causing airway compression: Perioperative anesthetic management. Ann Card Anaesth 2021; 24:250-252. [PMID: 33884988 PMCID: PMC8253014 DOI: 10.4103/aca.aca_74_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Posterior mediastinal masses by their location pose a risk of compression of heart, great vessels and airway. These risks are further exaggerated, with the use of neuromuscular relaxants and lateral positioning during anesthesia. We report a case of a 2.5 months old baby with posterior mediastinal mass causing compression of left bronchus and significant mediastinal shift with respiratory distress as a primary complaint. This posterior mediastinal Mass (PMM) was removed by right lateral thoracotomy without the initial use of neuromuscular blockade till the pleura was opened.
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Affiliation(s)
- Amit Rastogi
- Department of Anaesthesiology, SGPGI, Lucknow, Uttar Pradesh, India
| | - Nishat Nasar
- Department of Anaesthesiology, SGPGI, Lucknow, Uttar Pradesh, India
| | - Ankur Mandelia
- Department of Paediatric Surgery, SGPGI, Lucknow, Uttar Pradesh, India
| | - Tapas K Singh
- Department of Anaesthesiology, SGPGI, Lucknow, Uttar Pradesh, India
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Gómez-Ríos MÁ, Nuño FC, Barreto-Calvo P. Anesthetic management of an infant with giant abdominal neuroblastoma. Braz J Anesthesiol 2017; 67:210-213. [PMID: 28236871 DOI: 10.1016/j.bjane.2014.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 07/21/2014] [Indexed: 11/29/2022] Open
Abstract
Neuroblastoma is the most common, non-central nervous system tumor of childhood. It has the potential to synthesize catecholamines. However, the presences of hypertension are uncommon. We report the perioperative management of a 15-month-old infant with giant abdominal neuroblastoma who presented severe hypertension. The pathophysiological alterations of neuroblastoma are reviewed and perioperative management presented.
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Affiliation(s)
- Manuel Ángel Gómez-Ríos
- Complejo Hospitalario Universitario de A Coruña, Departamento de Anestesiología y Medicina Perioperatoria, A Coruña, Spain.
| | - Federico Curt Nuño
- Complejo Hospitalario Universitario de A Coruña, Departamento de Anestesiología y Medicina Perioperatoria, A Coruña, Spain
| | - Purísima Barreto-Calvo
- Complejo Hospitalario Universitario de A Coruña, Departamento de Anestesiología y Medicina Perioperatoria, A Coruña, Spain
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Ganigara A, Ramavakoda CY, Srinivasan CM, Ganigara M. Dilated cardiomyopathy in a child with abdominal neuroblastoma and normal serum catecholamine levels: anaesthetic management and review of literature. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2017. [DOI: 10.1080/22201181.2017.1283742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Anuradha Ganigara
- Department of Pediatric Anesthesiology, Indira Gandhi Institute of Child Health, Bangalore, India
| | | | - Chandana M Srinivasan
- Department of Pediatric Anesthesiology, Indira Gandhi Institute of Child Health, Bangalore, India
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7
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[Anesthetic management of an infant with giant abdominal neuroblastoma]. Rev Bras Anestesiol 2017; 67:210-213. [PMID: 28081907 DOI: 10.1016/j.bjan.2016.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 07/21/2014] [Indexed: 11/20/2022] Open
Abstract
Neuroblastoma is the most common, non-central nervous system tumor of childhood. It has the potential to synthesize catecholamines. However, the presences of hypertension are uncommon. We report the perioperative management of a 15-month-old infant with giant abdominal neuroblastoma who presented severe hypertension. The pathophysiological alterations of neuroblastoma are reviewed and perioperative management presented.
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Romero M, Kapur G, Baracco R, Valentini RP, Mattoo TK, Jain A. Treatment of Hypertension in Children With Catecholamine-Secreting Tumors: A Systematic Approach. J Clin Hypertens (Greenwich) 2015; 17:720-5. [PMID: 26010736 DOI: 10.1111/jch.12571] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 03/10/2015] [Accepted: 03/19/2015] [Indexed: 11/28/2022]
Abstract
Management of blood pressure in children with pheochromocytoma and other catecholamine-secreting tumors (CSTs) is unique and challenging. The authors report a single-center experience using sequential α-adrenergic blockade (phenoxybenzamine), increased fluid intake, and β-blockade for presurgical management of 10 CSTs in children. In this retrospective review, mean duration for blood pressure control in preparation for surgery was 4.5±2.6 weeks. Intraoperative hypertension was noted transiently (<2 hours) in eight patients (80%) and was treated with continuous infusion of short-acting antihypertensive agents. Two (20%) patients required vasopressor medication infusion to manage intraoperative hypotension. Only two (20%) patients developed postoperative hypotension and required vasopressor medication infusion for <24 hours. All antihypertensive medications were discontinued in the immediate (≤4 days) postoperative period in 80% of patients. In conclusion, a systematic and multidisciplinary approach utilizing adrenergic blockade is effective in treating children with CSTs.
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Affiliation(s)
- Mauricio Romero
- Division of Nephrology and Hypertension, The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI
| | - Gaurav Kapur
- Division of Nephrology and Hypertension, The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI
| | - Rossana Baracco
- Division of Nephrology and Hypertension, The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI
| | - Rudolph P Valentini
- Division of Nephrology and Hypertension, The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI
| | - Tej K Mattoo
- Division of Nephrology and Hypertension, The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI
| | - Amrish Jain
- Division of Nephrology and Hypertension, The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI
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Gupta S, Prasad G, Kundu R, Maitra S. On table extubation after emergency thoracotomy for mediastinal mass in a neonate. J Clin Anesth 2015; 27:432-4. [PMID: 25912487 DOI: 10.1016/j.jclinane.2015.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 03/26/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Sumit Gupta
- ResidentDepartment of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ganga Prasad
- ProfessorDepartment of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Riddhi Kundu
- Resident, Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Souvik Maitra
- ResidentDepartment of Anaesthesiology, All India Institute of Medical Sciences New Delhi, India.
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Kako H, Taghon T, Veneziano G, Aldrink JH, Ayoob R, Tobias JD. Severe intraoperative hypertension after induction of anesthesia in a child with a neuroblastoma. J Anesth 2013; 27:464-7. [DOI: 10.1007/s00540-012-1544-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 12/09/2012] [Indexed: 11/29/2022]
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Hernandez MR, Shamberger RC, Seefelder C. Catecholamine-secreting neuroblastoma in a 4-month-old infant: perioperative management. J Clin Anesth 2009; 21:54-6. [PMID: 19232942 DOI: 10.1016/j.jclinane.2008.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 06/03/2008] [Accepted: 06/09/2008] [Indexed: 12/01/2022]
Abstract
Preoperative alpha- and beta-adrenergic receptor block with phenoxybenzamine and labetalol, the intraoperative course of a 4-month-old infant with neuroblastoma and elevated catecholamines causing sweating, hypertension, and tachycardia, are presented. We recommend determination of catecholamine levels and pretreatment with alpha-adrenergic and--if needed--beta-adrenergic receptor antagonists in infants with neuroblastoma and hypertension, tachycardia, or sweating.
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Affiliation(s)
- Michael R Hernandez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Children's Hospital Boston, Boston, MA 02115, USA.
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Deutsch E, Tobias JD. Vasopressin to treat hypotension after pheochromocytoma resection in an eleven-year-old boy. J Cardiothorac Vasc Anesth 2006; 20:394-6. [PMID: 16750744 DOI: 10.1053/j.jvca.2005.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Indexed: 11/11/2022]
Affiliation(s)
- Eric Deutsch
- University of Missouri School of Medicine, Columbia, 65212, USA
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Abstract
OBJECTIVES To present the more frequent solid tumors, that require a general anaesthesia and to describe the particularities of the anaesthetic management. DATA SOURCES AND EXTRACTION The PUBMED database was searched for articles (1990 - 2005) combined with references analysis of major articles on the topics. DATA SYNTHESIS Neoplasma is the first cause of paediatric death. In children less than 5 years of age, neuroblastoma and nephroblastoma are the more frequent of the tumour. The incidence of each pathology is low. However a general anaesthesia is required in numerous situations: bone marrow aspiration and biopsy, central venous catheter insertion, various biopsies under computed tomography, ultrasound, thoracoscopy or laparoscopy, MRI scan, surgery and body radiation. The key points of successful anaesthetic management include complete preoperative evaluation together with the oncology paediatric team. Particularly, cardiotoxicity may result from chemotherapy and hypertension is frequently associated with neuroblastoma and nephroblastoma. Mediastinal location of lymphomas induced a significant risk of cardiopulmonary complications during induction of general anaesthesia. A peak expiratory flow rate or a tracheal cross-section area less than 50% of predicted values are contraindication to general anaesthesia. Cephalic rhabdomyosarcoma may be responsible of difficult airway management. Specific guidelines are available for platelet and red cell transfusion in paediatric oncology patients. Surgical antibioprophylaxis are adapted in immunodepressed children to a potential increased risk of postoperative infectious complications, according personal previous history, microbiological ecology and body bacterial flora. Dosage of anaesthetic agents takes into account denutrition, hydroelectrolytic disturbances and hypovolemia.
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Affiliation(s)
- C Lejus
- Service anesthésie-réanimation chirurgicale, Hôtel-Dieu-hôpital Mère-Enfant, CHU de Nantes, 44093 Nantes cedex, France.
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Tobias JD. Preoperative blood pressure management of children with catecholamine-secreting tumors: time for a change. Paediatr Anaesth 2005; 15:537-40. [PMID: 15960635 DOI: 10.1111/j.1460-9592.2005.01649.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chauty A, Raimondo G, Vergeron H, Branchereau S, Dessemme P, Devictor D, Hartmann O. [Discovery of a neuroblastoma producing cardiogenic shock in a 2-month-old child]. Arch Pediatr 2002; 9:602-5. [PMID: 12108315 DOI: 10.1016/s0929-693x(01)00928-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
CASE REPORT A two-month-old male child presented a severe heart failure associated with a malignant hypertension. Abdominal ultrasound revealed a mass connected to the left adrenal gland. CT scan showed a tumor of 7 x 6 x 8 cm, forcing back both the left kidney and the aorta. A biopsy allowed the diagnosis of neuroblastoma without MYCN oncogene amplification. Intensive care stabilized the hemodynamic situation. Under chemotherapy the tumor volume decreased significantly and complete surgical excision became possible. Three years after diagnosis, the patient remained in complete remission. CONCLUSION Clinical presentation of this neuroblastoma was extremely uncommon. The catecholamines produced by the tumoral cells could induce an increase of the myocardiac work following the left ventricule post charge increase. Theses mechanisms could be synergistic for a myocardial exhaustion.
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Affiliation(s)
- A Chauty
- Département de pédiatrie, institut Gustave-Roussy, 94805 Villejuif, France
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Abstract
The safe anaesthetic management of a child with a phaeochromocytoma requires an understanding of the pathophysiology of the disease, together with a thorough knowledge of its pharmacology, in order to avoid or minimize the potentially harmful cardiovascular changes that may occur during anaesthesia. Although there is a considerable amount of information on the management of the adult with phaeochromocytoma, much less has been written concerning children with the disease. Children differ significantly from adults in the incidence, location, presentation and management of this condition and these differences are discussed here together with some of the more controversial issues of management.
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Affiliation(s)
- H A Hack
- Royal Children's Hospital, Flemington Road, Parkville 3052, Victoria, Australia
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Gruner M, Larroquet M, Balquet P. Place of surgery in malignant mediastinal tumors in children. Pediatr Pulmonol Suppl 1998; 16:182. [PMID: 9443264 DOI: 10.1002/ppul.1950230896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- M Gruner
- Hôpital d'Enfants Armand-Trousseau, Paris
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