Background
Intraoperative hypertension is common during general anesthesia, but it is usually well managed without serious complications. However, severe hypertension can cause cardio-cerebrovascular complications such as myocardial ischemia, arrhythmia, cerebral hemorrhage, or aortic dissection during the perioperative period. Although controlling blood pressure has become easier to accomplish due to the development of anesthetic techniques and antihypertensives, severe hypertension still remains a challenging issue. In particular, severe hypertension associated with secondary causes such as pheochromocytoma, carcinoid syndrome, or thyroid storm are even more difficult to manage during an operation.
The adrenal gland stores and discharges catecholamines into the blood stream by activation of the sympathetic nervous system. Surgical manipulation of the adrenal gland, especially in the catecholamine producing tumors such as pheochromocytoma and paragangliomas, may cause a catecholamine surge resulting in hypertensive crisis intraoperatively. Furthermore, a case of severe hypertension caused by radiofrequency ablation of a metastatic adrenal gland tumor with normal neuroendocrine function has been reported.
We report a case of abrupt and severe hypertension, with systolic blood pressures over 350 mmHg, during a right hemi-hepatectomy in which the normal neuroendocrine functioning adrenal gland was electrically stimulated by monopolar electrocautery to separate the liver from the adrenal gland.