Perioperative anesthetic management of ectopic ACTH syndrome

Objective: To explore the best perioperative anesthetic management of ectopic ACTH syndrome.Methods: 5 patients with ectopic ACTH syndrome underwent operations of resecting primary tumor during general anaesthesia after preoperative preparation of supplementing potassium and decreasing plasma glucose levels and reducing blood pressure. Anaesthetic dose was half of the normal usage. All patients were injected Dexamethasone 10mg after tracheal intubation. Two cases were intravenously infused hydrocortisone 100mg after cutting out neoplasms. Blood gas was periodly measured. Plasma ACTH and cortisol levels were also measured at the time of before operations, exposing tumors, after removing tumors 0h, 1h and 5h. Potassium and hydrocortisone i.v. infusion were continued after operations. Results: Two cases had severe hypokalemia and potassium was supplemented during operations. ACTH significantly increased when exposing tumors （P＜0.01） and markedly decreased when tumors were cut away（ P＜0.01）. Adrenocortical crisis occurred in one patient after 8h of postoperation. BP and HR gradually returned to normal range after using hydrocortisone.Plasma potassium and ACTH and cortisol went back to normal scope within 24h. （Conclusion: It’s） important of perioperative supplementing potassium, diminishing plasma glucose, and preclusive using of hydrocortisone to help patients go through operations safely.