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Canadian Journal of Anesthesia, Vol 31, 206-209, Copyright © 1984 by Canadian Anesthesiologists' Society

Phentolamine en Perfusion Continue Dans le Traitement D'une Hypertension Arterielle Sévère Associée à un Neuroblastome

LUCILLE CHAMPOUX MD FRCP(C)1 and MARIE GAUTHIER MD1

1 Départements d'anesthésie-réanimation et de pédiatrie Université de Montréal; unité des soins intensifs Hôpital Ste-Justine, Montréal

Adresser la correspondance à: Marie Gauthier MD, Hôpital Sainte-Justine, 3175 Côte Ste-Catherine, Montréal, Canada, H3T 1C5.

Treatment of severe arterial hypertension associated with neuroblastoma is not well discussed in the literature. A six-month-old boy was referred for evaluation of an abdominal mass which proved to be neuroblastoma stage IV. Arterial hypertension of 26/16 kPa (190/110 mmHg) was also found. Because of the degree of malignancy and the risk of intra-tumoral haemorrhage, urgent management of the hypertension was required before proceeding to surgery. Phentolamine, a short-acting a-blocking agent, was administered as a continuous infusion of a 0.01 per cent solution, at a rate of 1 to 4 µg·kg-1·min-1 titrated according to the arterial blood pressure(BP), central venous pressure and urinary output. BP was rapidly controlled and the child went to surgery within 48 hours. The operation was uneventful but only 80per cent of the tumour could be resected. Phentolamine was discontinued intraoperatively but was reinstituted postoperatively when hypertension recurred. With the return of normal intestinal function five days after surgery, phenoxybenzamine was begun p.o. and phentolamine was tapered over 24 hours and discontinued.

A continuous infusion of phentolamine provided satisfactory control pre- and post-operatively with no significant hypotension. We consider this technique to be potentially very useful in the management of severe arterial hypertension associated with neuroblastoma, as it permits early surgical intervention under optimal conditions.

Key Words: SYMPATHETIC NERVOUS SYSTEM, SYMPATHOLYTIC AGENTS: phentolamine • SURGERY: neuroblastoma






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Copyright © 1984 by the Canadian Anesthesiologists' Society.