Giant paraganglioma in a child: Medical and anaesthetic concerns

Paraganglioma is a rare neuroendocrine catecholamine producing tumour in childhood which arises outside the adrenal medulla. We present a 12 year old girl with giant paraganglioma with severe hypertension and end organ damage. Diagnosis was confirmed with 24 h urinary Vanillymandelic Acid (VMA) and CT scan. Preoperative blood pressure was controlled with intravenous nitroprusside, and oral prazosin, amlodepine, labetalol and metoprolol. General anaesthesia with epidural analgesia was given. Intra operative blood pressure rise was managed with infusion of nitriglycerine (NTG), esmolol, nitroprusside and propofol.