A bichon frise, previously diagnosed with a phaeochromocytoma, underwent phenoxybenzamine treatment 17 days before adrenalectomy. Preoperative haematology, biochemistry and oscillometric blood pressure readings for the 12 year old were typical. Before anaesthesia, methadone and medetomidine were administered intramuscularly. Anaesthesia was induced using propofol titrated to permit endotracheal intubation and maintenance of anaesthesia using an isoflurane in oxygen mixture. Invasive blood pressure monitoring by a cannula in a dorsal pedal artery promptly revealed life-threatening hypertension. Rapid increase in isoflurane concentration, multiple intravenous fentanyl boluses administration and commencement of an esmolol citrate infusion were unsuccessful in attenuating the hypertension observed. Rapid rises in end-tidal carbon dioxide and resultant tachypnoea necessitated atracurium intravenously and positive pressure ventilation. Hypertension was eventually abolished using intravenous acepromazine, which ultimately caused a hypotensive nadir. Reduction in anaesthetic depth and aggressive fluid therapy resolved hypotension before termination of anaesthesia. Management of hypertension in dogs with phaeochromocytoma remains challenging.
- Blood pressure
- Adrenal gland
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Contributors Both authors contributed comprehensively to the case report. JPF primarily managed the case under direct guidance of JR. Both authors were involved in the composition, critiquing and final approval of the draft attached.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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