Anesthesia Management of Two Operations for Nonfunctional Bladder Paraganglioma

Case Report

Austin J Cancer Clin Res. 2023; 10(2): 1111.

Anesthesia Management of Two Operations for Nonfunctional Bladder Paraganglioma

Wang LL¹; Liang ZL²*

¹Medical College of Yanbian University, China

²Department of Anesthesiology, Yanbian University, China

*Corresponding author: Liang ZL Department of Anesthesiology, Yanbian University, 1327 Juzi St, China. Tel: 15526770727 Email: zlliang@ybu.edu.cn

Received: November 21, 2023 Accepted: December 16, 2023 Published: December 22, 2023

Abstract

Nonfunctional paragangliomas are perioperatively hemodynamically unstable and prone to lethal complications, making anesthesia a high surgical risk. We report the perioperative management of an unanticipated paraganglioma of the bladder over two surgical procedures. The patient developed a hypertensive crisis during the first intraoperative electrodesiccation of the tumor, and the surgeon stopped the operation and sent intraoperative cryopreservation, which was considered a paraganglioma of the bladder. Postoperative histopathological and immunohistochemical results confirmed the case as a paraganglioma of the bladder. Because of the high risk of continuing the surgery, a second surgery was performed after perfecting the preoperative preparation. The patient’s vital signs were stable during the second surgery and the patient’s prognosis was good after the surgery. An unanticipated intraoperative paraganglioma is a major perioperative challenge for anesthesiologists, and the improvement of its outcome is mainly due to good preoperative preparation, intraoperative hemodynamic monitoring, and the application of rapid, potent, and short-acting vasoactive drugs.

Keywords: Paraganglioma; Anesthesia

Introduction

Bladder Paraganglioma (BPG) is a rare bladder tumor that accounts for approximately 0.06% of bladder tumors. Depending on the level of catecholamines and the patient's presentation, BPG can be classified as functional or nonfunctional [1]. Nonfunctional BPG is a major perioperative challenge for anesthesiologists only when the tumor suddenly releases large amounts of catecholamines triggering hypertension and tachycardia during examination or anesthesia procedures [2]. To our knowledge, there are many case reports in the previous literature describing the anesthetic management of paragangliomas, but there are very limited reports on the anesthetic management of nonfunctional paragangliomas. Here, we present a case of an unanticipated patient with nonfunctional BPG who developed a hypertensive crisis during the first surgery. After rapid judgment and secondary preoperative preparation, the patient eventually completed the second surgery with a good prognosis.

Case Presentation (Report)

The patient was a 54-year-old male, weighing 62 kg, with a BMI of 18.21 kg/m2. He was admitted to the hospital for 2 days because of a bladder mass found on physical examination. He had a history of hypertension for 5 years, with a maximum blood pressure of 140/100mmHg. He took oral antihypertensive drugs regularly and complained of fair blood pressure control. On admission: BP 134/84 mmHg; abdomen flat and soft, both kidneys symmetrical, not palpable, no pressure pain and percussion pain, no pressure pain along the ureteral travel area; no obvious elevation in the bladder area. Laboratory tests: occult blood +2, urine red blood cells 92.50/ul, red blood cells (high magnification field) 16.65/HPF; normal liver and kidney function and coagulation function tests. Chest CT showed: bilateral septal parapneumonic. Cardiac ultrasound and electrocardiogram findings were normal. Urological ultrasound showed that the bladder was occupied, and the posterior wall of the bladder was about 26*20mm weak strong echogenicity near the right ureter. Abdominal CT showed fair bladder filling, and wall thickening, and a soft tissue density shadow was seen in the right lower wall of the bladder, protruding into the lumen, with a long diameter of about 2.4 cm, with significant and sustained enhancement (Figure 1). The cystoscopy showed a mass with a size of about 5*5 cm in the right parietal wall of the bladder near the internal urethral orifice. its surface mucosa was smooth, and the mucosa of the right wall, right posterior wall, and right parietal wall of the bladder were congested and edematous. the rest of the bladder wall showed no abnormality, and the bilateral ureteral openings were normal. The clinical diagnosis was: a bladder tumor. Due to the large size of the tumor, surgical treatment was required. Trans-urethral bladder tumor plasmapheresis was proposed to be performed under general anesthesia at an elective stage.

Citation: Wang LL, Liang ZL. Anesthesia Management of Two Operations for Nonfunctional Bladder Paraganglioma. Austin J Cancer Clin Res. 2023; 10(2): 1111.