Anesthetic Challenges in a Rare Case of Lower Thoracic Prevertebral Functional Paraganglioma Excision under Combined Epidural and General Anesthesia: A Case Report

Abstract

The incidence of paraganglioma has been reported between 2-8 cases per million people yearly. Thoracic functional Paragangliomas accounts for 15-20% of pheochromocytomas derived from chromaffin cells and secretes catecholamines. It has high mortality rate challenging anaesthetic management. Undiagnosed paraganglioma have an extremely high mortality rate up to 60%. The present report is a case of successful management of functional paraganglioma excision at the level of T9-T11 feeding from the descending aorta. A 71-year-old male with lower thoracic functional paraganglioma was posted for excision. Pre-anaesthetic evaluation, revealed history of Ischemic Heart Disease, Hypertension and PTCA 1month prior and intake of regular cardiac medication preoperatively, along with regular medications of Tab Propranolol 10mg and Tab Bisoprolol 2.5mg. PR was 84 bpm and BP was 140/90 mmHg in a supine position and 90/60 mmHg on standing. Echocardiography indicated EF 50% with borderline LV function. Epidural and General Anaesthesia was administered. Continuous roller coaster fluctuations in haemodynamics for intraoperative period of 8hrs, risk challenges calibrated by continuous vasopressor and vasodilation infusions. Extubation and post-operative period were uneventful. Careful perioperative management, including preoperative cardiovascular stabilization and intraoperative hemodynamic monitoring, is crucial in functional paraganglioma cases to prevent mortality and complications.