Chuan Wang1, Wenqiong Xin1, Yi Ji2. 1. Department of Pediatric Surgery, West China Hospital of Sichuan University, #37 Guo-Xue-Xiang, 610041, Chengdu, China. 2. Department of Pediatric Surgery, West China Hospital of Sichuan University, #37 Guo-Xue-Xiang, 610041, Chengdu, China. jijiyuanyuan@163.com.
Abstract
BACKGROUND: Neuroblastoma is the most common malignant extracranial solid tumor in pediatrics patients. Intraoperative hyperthermia is extremely rare in patients with neuroblastoma and can cause a series of complications. Here, we represent a case of neuroblastoma accompanied by hyperthermia during anesthesia, and propose a rational explanation and management options. CASE PRESENTATION: The patient had gait disturbance and sitting-related pain without fever. Magnetic resonance imaging revealed a soft tissue mass located in the right posterior mediastinum, paravertebral space and canalis vertebralis. Serum tumor marker screening showed that the patient had increased epinephrine, norepinephrine and neuron specific enolase levels, with an increased 24 hour urine vanillylmandelic acid level. Intraspinal tumor resection was conducted. The temperature of the patient rapidly arose to 40.1 °C over 10 minutes when waiting for tracheal extubation. The arterial gas analysis results indicated malignant hyperthermia was less likely, and dantrolene was not administered. Physical cooling methods were used, and the temperature dropped to 38.6 ℃. The trachea was successfully extubated. Histological results confirmed the diagnosis of neuroblastoma. CONCLUSIONS: Hyperthermia during anesthesia is a serious adverse event. Catecholamines secreted from neuroblatoma cells can lead to hypermetabolism and hyperthermia. Surgeons and anesthesiologists should be aware of the possibility of hyperthermia in patients with neuroblastoma.
BACKGROUND:Neuroblastoma is the most common malignant extracranial solid tumor in pediatrics patients. Intraoperative hyperthermia is extremely rare in patients with neuroblastoma and can cause a series of complications. Here, we represent a case of neuroblastoma accompanied by hyperthermia during anesthesia, and propose a rational explanation and management options. CASE PRESENTATION: The patient had gait disturbance and sitting-related pain without fever. Magnetic resonance imaging revealed a soft tissue mass located in the right posterior mediastinum, paravertebral space and canalis vertebralis. Serum tumor marker screening showed that the patient had increased epinephrine, norepinephrine and neuron specific enolase levels, with an increased 24 hour urine vanillylmandelic acid level. Intraspinal tumor resection was conducted. The temperature of the patient rapidly arose to 40.1 °C over 10 minutes when waiting for tracheal extubation. The arterial gas analysis results indicated malignant hyperthermia was less likely, and dantrolene was not administered. Physical cooling methods were used, and the temperature dropped to 38.6 ℃. The trachea was successfully extubated. Histological results confirmed the diagnosis of neuroblastoma. CONCLUSIONS:Hyperthermia during anesthesia is a serious adverse event. Catecholamines secreted from neuroblatoma cells can lead to hypermetabolism and hyperthermia. Surgeons and anesthesiologists should be aware of the possibility of hyperthermia in patients with neuroblastoma.
Authors: I R N Verly; R Leen; J R Meinsma; G K J Hooijer; C D Savci-Heijink; J van Nes; M Broekmans; R J A Wanders; A B P van Kuilenburg; G A M Tytgat Journal: Eur J Cancer Date: 2019-02-22 Impact factor: 9.162
Authors: Erika A Newman; Shahab Abdessalam; Jennifer H Aldrink; Mary Austin; Todd E Heaton; Jennifer Bruny; Peter Ehrlich; Roshni Dasgupta; Reto M Baertschiger; Timothy B Lautz; Daniel S Rhee; Max R Langham; Marcus M Malek; Rebecka L Meyers; Jaimie D Nathan; Brent R Weil; Stephanie Polites; Mary Beth Madonna Journal: J Pediatr Surg Date: 2018-09-19 Impact factor: 2.545