Neuroblastoma is the most common, non-central nervous system tumor of childhood. It has the potential to synthesize catecholamines. However, the presences of hypertension are uncommon. We report the perioperative management of a 15-month-old infant with giant abdominal neuroblastoma who presented severe hypertension. The pathophysiological alterations of neuroblastoma are reviewed and perioperative management presented.
KEYWORDS
Neuroblastoma; Pediatric anesthesia; Infant; Hypertension
| Drug | Route of administration | Dose | Notes |
|---|---|---|---|
| Clonidine | PO | 5-10 g/kg 24 h (2-4 doses) | α2-adrenergic agonist. Risk of prolonged sedation. |
| Nifedipine | PO | 0.25-0.5 mg/kg 4-6 h | Dihydropyridine calcium antagonist. Predominantly vascular effects. |
| Propranolol | PO/IV | 0.05-0.2 mg/kg iv 0.5-1 mg/kg 24 h (3-4 doses) vo |
Nonselective β blockade. Risk of bronchospasm, myocardial dysfunction, AV block and hypoglycemia. |
| Labetalol | IV | 0.25-1 mg/kg/h | Nonselective blockade. Side effects are similar to those of propranolol. |
| Esmolol | IV | 50-200 µg/kg/min | Relatively selective blockade. Short half-life (10 min). |
| Sodium nitroprusside | IV | 0.5-10 µg/kg/min | Potent direct relaxation of vascular muscle tissue, both arteriolar and venous capacitance vessels. Potential cyanide toxicity; reflex tachycardia. |
| Nitroglycerin | IV | 0.5-10 µg/kg/min | Direct smooth muscle relaxation, predominantly of venous capacitance vessels. |
| Phentolamine | IV | 0.5-5 µg/kg/min | Selective blocker, mainly arteriolar vasodilation. |
| Hydralazine | IV | 0.1-0.2 mg/kg 6 h | Direct smooth muscle relaxation, predominantly of arteriolar. Long half-life. Tachyphylaxis; reflex tachycardia; thrombocytopenia; lupus-like syndrome. |
| Urapidil | IV | Initially: 2 mg/kg/h Maintenance: 0.8 mg/kg/h. Max. 7 days |
Elective antagonist of peripheral postsynaptic 1-adrenergic receptors. |
| Enalapril | PO/IV | 0.1-0.5 mg/kg 24 h (1-2 doses) PO 5-10 µg/kg 8-24 h iv |
Angiotensin converting enzyme inhibitor. Effect of long duration. Hyperkalemia, renal failure, angioedema; severe hypotension with anesthetic agents. |
