Anaesthetic problems

1. Hypertension and sodium retention. Hypertensive peaks may occur at intubation. Patients may be receiving multiple antihypertensives, with potential for drug interactions.

2. Low total body and plasma potassium levels cause muscle weakness and increased sensitivity to nondepolarising muscle relaxants.A pregnant woman presented at 29 weeks' gestation with muscle weakness, hypertension, and severe hypokalaemia (Fujiyama et al 1999). Intraoperative arrhythmias may also be produced.A patient in whom tonic muscle contractions occurred during induction, and whose subsequent potassium balance studies suggested that the potassium stores had been depleted by 30—40%, has been described (Gangat et al 1976). Sudden ventricular fibrillation was reported in a 37-year-old, otherwise healthy, woman.A serum potassium of1.4mmoll-1 and a right sided adrenal tumour were found (Abdo et al 1999).

3. Pregnancy occurred in a patient being investigated for probable Conn's syndrome. During the first trimester, blood pressure and serum potassium were so difficult to control that adrenalectomy was performed at 15 weeks' gestation (Solomon et al 1996). Another patient presented with weakness, hypertension and severe hypokalaemia at 29 weeks' gestation (Fujiyama et al 1999).There is dispute about the appropriate time to perform resection in the pregnant patient. Since the condition is difficult to treat at this time, and medical therapy is probably more risky than surgery, it has been suggested that surgery should be performed early in the second trimester (Baron et al 1995, Harrington et al 1999).Two patients who had been normotensive during their pregnancies developed severe postpartum hypertension, one at at 18 days, the other at 1 month. Both patients had mild hypokalaemia, and adrenal tumours were demonstrated and subsequently resected (Nezu et al 2000).

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