Limits...
Anesthetic management of hypertensive crisis in a three-year-old patient with undiagnosed severe renal artery stenosis: a case report.

Park SH, Lee YS, Min TJ, Kim WY, Kim JH, Park YC - Korean J Anesthesiol (2014)

Bottom Line: Hypertension commonly occurs during general anesthesia, and is usually promptly and appropriately treated by anesthesiologists.However in children with severe, unexplained, or refractory hypertension, it has the potential to cause morbidity and even mortality in susceptible patients.We report an anesthetic management of an unexpected hypertensive crisis that developed during general anesthesia in a three-year-old girl with undiagnosed severe left renal artery stenosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Korea.

ABSTRACT
Pediatric hypertensive crisis is a potentially life threatening medical emergency, usually secondary to an underlying disease. Hypertension commonly occurs during general anesthesia, and is usually promptly and appropriately treated by anesthesiologists. However in children with severe, unexplained, or refractory hypertension, it has the potential to cause morbidity and even mortality in susceptible patients. We report an anesthetic management of an unexpected hypertensive crisis that developed during general anesthesia in a three-year-old girl with undiagnosed severe left renal artery stenosis.

No MeSH data available.


Related in: MedlinePlus

Abdomen CT angiography shows stenosis at the proximal portion of left renal artery, hypoplasia, and decreased perfusion in left kidney.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4216791&req=5

Figure 1: Abdomen CT angiography shows stenosis at the proximal portion of left renal artery, hypoplasia, and decreased perfusion in left kidney.

Mentions: In the pediatric ward, an additional labetalol 0.4-3 mg/kg/h IV infusion was started, and diltiazem 3.5 mg/kg/day, atenolol 1 mg/kg/day, and hydralazine 7.2 mg/kg/day were given orally. Administration of these drugs was effective, but BP still showed fluctuation from 95/45 to 145/75 mmHg. Concurrently, further evaluation to establish the cause of uncontrollable hypertension was performed. She had no past medical history and physical examinations were unremarkable. In laboratory findings, plasma renin activity was elevated up to 24.2 ng/ml/h (normal range: 0.29-3.7 ng/ml/h). Plasma epinephrine and norepinephrine soared to 411.66 pg/ml (normal range: 0-120 pg/ml) and 1,063.31 pg/ml (normal range: 0-410 pg/ml) respectively. Other laboratory findings were all within normal limits. In imaging analyses, renal ultrasound showed a decrease in the size of the left kidney (5.7 cm in length) and no abnormalities were detected in the right kidney. Abdominal CT-angiography scan showed severe stenosis of inner diameter of less than 1 mm at proximal portion of left renal artery, hypoplasia, and decreased perfusion in left kidney (Fig. 1). Tc-99m DMSA renal scan also revealed decreased uptake in left kidney (Fig. 2). Echocardiography and fundoscopy were unremarkable. The options for treatment were balloon angioplasty or renal revascularization or nephrectomy. In this case, left nephrectomy was recommended due to the patient's age and the size of involved renal artery. Therefore, left laparoscopic nephrectomy was planned and she was transferred to the genitourinary department for surgery.


Anesthetic management of hypertensive crisis in a three-year-old patient with undiagnosed severe renal artery stenosis: a case report.

Park SH, Lee YS, Min TJ, Kim WY, Kim JH, Park YC - Korean J Anesthesiol (2014)

Abdomen CT angiography shows stenosis at the proximal portion of left renal artery, hypoplasia, and decreased perfusion in left kidney.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4216791&req=5

Figure 1: Abdomen CT angiography shows stenosis at the proximal portion of left renal artery, hypoplasia, and decreased perfusion in left kidney.
Mentions: In the pediatric ward, an additional labetalol 0.4-3 mg/kg/h IV infusion was started, and diltiazem 3.5 mg/kg/day, atenolol 1 mg/kg/day, and hydralazine 7.2 mg/kg/day were given orally. Administration of these drugs was effective, but BP still showed fluctuation from 95/45 to 145/75 mmHg. Concurrently, further evaluation to establish the cause of uncontrollable hypertension was performed. She had no past medical history and physical examinations were unremarkable. In laboratory findings, plasma renin activity was elevated up to 24.2 ng/ml/h (normal range: 0.29-3.7 ng/ml/h). Plasma epinephrine and norepinephrine soared to 411.66 pg/ml (normal range: 0-120 pg/ml) and 1,063.31 pg/ml (normal range: 0-410 pg/ml) respectively. Other laboratory findings were all within normal limits. In imaging analyses, renal ultrasound showed a decrease in the size of the left kidney (5.7 cm in length) and no abnormalities were detected in the right kidney. Abdominal CT-angiography scan showed severe stenosis of inner diameter of less than 1 mm at proximal portion of left renal artery, hypoplasia, and decreased perfusion in left kidney (Fig. 1). Tc-99m DMSA renal scan also revealed decreased uptake in left kidney (Fig. 2). Echocardiography and fundoscopy were unremarkable. The options for treatment were balloon angioplasty or renal revascularization or nephrectomy. In this case, left nephrectomy was recommended due to the patient's age and the size of involved renal artery. Therefore, left laparoscopic nephrectomy was planned and she was transferred to the genitourinary department for surgery.

Bottom Line: Hypertension commonly occurs during general anesthesia, and is usually promptly and appropriately treated by anesthesiologists.However in children with severe, unexplained, or refractory hypertension, it has the potential to cause morbidity and even mortality in susceptible patients.We report an anesthetic management of an unexpected hypertensive crisis that developed during general anesthesia in a three-year-old girl with undiagnosed severe left renal artery stenosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Korea.

ABSTRACT
Pediatric hypertensive crisis is a potentially life threatening medical emergency, usually secondary to an underlying disease. Hypertension commonly occurs during general anesthesia, and is usually promptly and appropriately treated by anesthesiologists. However in children with severe, unexplained, or refractory hypertension, it has the potential to cause morbidity and even mortality in susceptible patients. We report an anesthetic management of an unexpected hypertensive crisis that developed during general anesthesia in a three-year-old girl with undiagnosed severe left renal artery stenosis.

No MeSH data available.


Related in: MedlinePlus