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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research
Faisal Irwanda
Unknown Affiliation
Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience

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Successful Anesthetic Management of Pheochromocytoma in a Patient with Preoperative Hypertension: A Case Report Faisal Irwanda; Novita Anggraeni
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 3 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i3.1222

Abstract

Background: Pheochromocytoma, a rare tumor arising from chromaffin cells in the adrenal medulla, poses significant anesthetic challenges due to its propensity to release catecholamines, potentially leading to life-threatening hypertensive crises. This case report describes the successful anesthetic management of a patient with pheochromocytoma presenting with preoperative hypertension. Case presentation: A 37-year-old female with a 12x5 cm right adrenal tumor diagnosed as pheochromocytoma was scheduled for adrenalectomy. She presented with a history of uncontrolled hypertension, episodic headaches, diaphoresis, and palpitations. Preoperative management focuses on blood pressure control using alpha and beta-adrenergic blockers. Anesthesia was induced with propofol, fentanyl, and atracurium, while nitroglycerin and sevoflurane were used to maintain hemodynamic stability. The patient's blood pressure was closely monitored throughout the procedure, with interventions made to manage fluctuations during tumor manipulation. Conclusion: Successful anesthetic management of pheochromocytoma requires meticulous preoperative preparation, vigilant intraoperative monitoring, and prompt pharmacological interventions. This case highlights the importance of a multidisciplinary approach, including endocrinologists, anesthesiologists, and surgeons, to optimize patient outcomes.
Thoracic Epidural Anesthesia Facilitating Upper Abdominal Surgery in the Presence of Malignant Pleural Effusion and Hepatic Metastases: A Case Report Faisal Irwanda; Andre Azhar; Dino Irawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 7 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i7.1343

Abstract

Background: Upper abdominal surgery in patients with advanced metastatic cancer, particularly with significant pulmonary and hepatic involvement, presents substantial perioperative challenges. Malignant pleural effusion (MPE) and hepatic metastases compromise cardiorespiratory reserve, increasing the risks associated with general anesthesia and surgical stress. Thoracic epidural anesthesia (TEA) offers potential benefits by providing effective analgesia, reducing pulmonary complications, and attenuating the surgical stress response. Case presentation: We report the case of a 65-year-old male patient with metastatic breast cancer involving the lungs, liver, and spine, complicated by recurrent malignant pleural effusion. He presented with dyspnea and abdominal pain, requiring a laparotomy for liver biopsy to guide further oncological management. Given his ASA III status, significant pulmonary compromise (pre-operative SpO2 93-94% on room air, effusion requiring drainage), and the nature of the surgery, TEA was chosen as the primary anesthetic technique. An epidural catheter was successfully placed at the T9-T10 interspace, achieving a T4 sensory block using ropivacaine 0.5%. The laparotomy and liver biopsy proceeded with stable intraoperative hemodynamics and adequate surgical conditions. Conclusion: TEA provided effective anesthesia and analgesia for upper abdominal surgery in this high-risk patient with extensive metastatic disease and compromised pulmonary function. This approach facilitated the procedure while maintaining hemodynamic stability and avoiding the potential respiratory complications associated with general anesthesia and tracheal intubation. TEA should be considered a viable anesthetic option in carefully selected high-risk patients undergoing abdominal oncological surgery.
Thoracic Epidural Anesthesia Facilitating Upper Abdominal Surgery in the Presence of Malignant Pleural Effusion and Hepatic Metastases: A Case Report Faisal Irwanda; Andre Azhar; Dino Irawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 7 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i7.1343

Abstract

Background: Upper abdominal surgery in patients with advanced metastatic cancer, particularly with significant pulmonary and hepatic involvement, presents substantial perioperative challenges. Malignant pleural effusion (MPE) and hepatic metastases compromise cardiorespiratory reserve, increasing the risks associated with general anesthesia and surgical stress. Thoracic epidural anesthesia (TEA) offers potential benefits by providing effective analgesia, reducing pulmonary complications, and attenuating the surgical stress response. Case presentation: We report the case of a 65-year-old male patient with metastatic breast cancer involving the lungs, liver, and spine, complicated by recurrent malignant pleural effusion. He presented with dyspnea and abdominal pain, requiring a laparotomy for liver biopsy to guide further oncological management. Given his ASA III status, significant pulmonary compromise (pre-operative SpO2 93-94% on room air, effusion requiring drainage), and the nature of the surgery, TEA was chosen as the primary anesthetic technique. An epidural catheter was successfully placed at the T9-T10 interspace, achieving a T4 sensory block using ropivacaine 0.5%. The laparotomy and liver biopsy proceeded with stable intraoperative hemodynamics and adequate surgical conditions. Conclusion: TEA provided effective anesthesia and analgesia for upper abdominal surgery in this high-risk patient with extensive metastatic disease and compromised pulmonary function. This approach facilitated the procedure while maintaining hemodynamic stability and avoiding the potential respiratory complications associated with general anesthesia and tracheal intubation. TEA should be considered a viable anesthetic option in carefully selected high-risk patients undergoing abdominal oncological surgery.
Co-Authors Andre Azhar Dino Irawan Novita Anggraeni