Pheochromocytoma, Fulminant Heart Failure, and a Phenylephrine Challenge. The Perioperative Management of Adrenalectomy in a Jehovah’s Witness Patient: A Case Report
Perioperative management of pheochromocytoma in the setting of catecholamine-induced heart failure requires careful consideration of hemodynamic optimization and possible mechanical circulatory support. A Jehovah’s Witness patient with catecholamine-induced acutely decompensated heart failure requir...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Sciendo
2021-11-01
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| Series: | The Journal of Critical Care Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.2478/jccm-2021-0038 |
| _version_ | 1797430177120124928 |
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| author | Bachman Sarah A. Peterson Ryan S. Burrage Peter S. Hickerson Leigh C |
| author_facet | Bachman Sarah A. Peterson Ryan S. Burrage Peter S. Hickerson Leigh C |
| author_sort | Bachman Sarah A. |
| collection | DOAJ |
| description | Perioperative management of pheochromocytoma in the setting of catecholamine-induced heart failure requires careful consideration of hemodynamic optimization and possible mechanical circulatory support. A Jehovah’s Witness patient with catecholamine-induced acutely decompensated heart failure required dependable afterload reduction for a cardio-protective strategy. This was emphasized due to the relative contraindication to perioperative anticoagulation required for mechanical circulatory support. A phenylephrine challenge clearly demonstrated adequate alpha blockade after only 24 hours of phenoxybenzamine treatment. This resulted in advancement of the surgery date. This case also highlights management of beta blockade, volume and salt loading, autologous blood transfusion, and profound post-operative vasoplegia in the setting of cardiogenic shock. Careful attention to hemodynamic optimization and cardio-protective strategies ultimately resulted in positive outcome for this challenging clinical scenario. |
| first_indexed | 2024-03-09T09:23:50Z |
| format | Article |
| id | doaj.art-37d804a30bcc43449e7796a84f81e7c9 |
| institution | Directory Open Access Journal |
| issn | 2393-1817 |
| language | English |
| last_indexed | 2024-03-09T09:23:50Z |
| publishDate | 2021-11-01 |
| publisher | Sciendo |
| record_format | Article |
| series | The Journal of Critical Care Medicine |
| spelling | doaj.art-37d804a30bcc43449e7796a84f81e7c92023-12-02T06:30:02ZengSciendoThe Journal of Critical Care Medicine2393-18172021-11-0181556010.2478/jccm-2021-0038Pheochromocytoma, Fulminant Heart Failure, and a Phenylephrine Challenge. The Perioperative Management of Adrenalectomy in a Jehovah’s Witness Patient: A Case ReportBachman Sarah A.0Peterson Ryan S.1Burrage Peter S.2Hickerson Leigh C3Dartmouth-Hitchcock Medical Center, Lebanon, NH, USADartmouth-Hitchcock Medical Center, Lebanon, NH, USADartmouth-Hitchcock Medical Center, Lebanon, NH, USADartmouth-Hitchcock Medical Center, Lebanon, NH, USAPerioperative management of pheochromocytoma in the setting of catecholamine-induced heart failure requires careful consideration of hemodynamic optimization and possible mechanical circulatory support. A Jehovah’s Witness patient with catecholamine-induced acutely decompensated heart failure required dependable afterload reduction for a cardio-protective strategy. This was emphasized due to the relative contraindication to perioperative anticoagulation required for mechanical circulatory support. A phenylephrine challenge clearly demonstrated adequate alpha blockade after only 24 hours of phenoxybenzamine treatment. This resulted in advancement of the surgery date. This case also highlights management of beta blockade, volume and salt loading, autologous blood transfusion, and profound post-operative vasoplegia in the setting of cardiogenic shock. Careful attention to hemodynamic optimization and cardio-protective strategies ultimately resulted in positive outcome for this challenging clinical scenario.https://doi.org/10.2478/jccm-2021-0038pheochromocytomasystolic heart failurestress cardiomyopathyvasoplegiabloodless medical and surgical procedures |
| spellingShingle | Bachman Sarah A. Peterson Ryan S. Burrage Peter S. Hickerson Leigh C Pheochromocytoma, Fulminant Heart Failure, and a Phenylephrine Challenge. The Perioperative Management of Adrenalectomy in a Jehovah’s Witness Patient: A Case Report The Journal of Critical Care Medicine pheochromocytoma systolic heart failure stress cardiomyopathy vasoplegia bloodless medical and surgical procedures |
| title | Pheochromocytoma, Fulminant Heart Failure, and a Phenylephrine Challenge. The Perioperative Management of Adrenalectomy in a Jehovah’s Witness Patient: A Case Report |
| title_full | Pheochromocytoma, Fulminant Heart Failure, and a Phenylephrine Challenge. The Perioperative Management of Adrenalectomy in a Jehovah’s Witness Patient: A Case Report |
| title_fullStr | Pheochromocytoma, Fulminant Heart Failure, and a Phenylephrine Challenge. The Perioperative Management of Adrenalectomy in a Jehovah’s Witness Patient: A Case Report |
| title_full_unstemmed | Pheochromocytoma, Fulminant Heart Failure, and a Phenylephrine Challenge. The Perioperative Management of Adrenalectomy in a Jehovah’s Witness Patient: A Case Report |
| title_short | Pheochromocytoma, Fulminant Heart Failure, and a Phenylephrine Challenge. The Perioperative Management of Adrenalectomy in a Jehovah’s Witness Patient: A Case Report |
| title_sort | pheochromocytoma fulminant heart failure and a phenylephrine challenge the perioperative management of adrenalectomy in a jehovah s witness patient a case report |
| topic | pheochromocytoma systolic heart failure stress cardiomyopathy vasoplegia bloodless medical and surgical procedures |
| url | https://doi.org/10.2478/jccm-2021-0038 |
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