Improvement of adenoidectomy for childhood snoring.

aspirin, and frusemide. The patient returned to Hong Kong for surgical removal of “atrial myxoma” in one of the private hospitals. During operation, routine cardiac monitors included electrocardiography, intraarterial cannula, and multilumen central venous catheter. After induction of anaesthesia (high-dose fentanyl, midazolam, thiopentone, and pancuronium), the systolic BP shot up from 145 to 220 mm Hg, while the heart rate increased from 100 to 120 beats per minute (bpm). This was controlled with boluses of propofol. The surgeon proceeded with sternotomy and aortic cannulation after systemic heparinisation. During right atrial manipulation, the BP again rose above 250 mm Hg requiring nitroprusside, propranolol, and phentolamine, which lowered the BP to the 130 mm Hg range. The possibility of a catecholamine-secreting tumour was contemplated. Nevertheless, after right atrial cannulation the patient was quickly put on cardiopulmonary bypass. The perfusion pressure was maintained at about 60 mm Hg without further vasodilator therapy. Right atriotomy showed no tumour. However, a whitish tumour mass measuring 3 cm x 4 cm was found adherent to the exterior right atrial surface and was resected. The atrial wall remained intact, and the patient was taken off bypass smoothly with minimal dopamine. The postoperative BP was 110 to 120 mm Hg with a junctional rhythm of 50 to 60 bpm. Pathological diagnosis was paraganglioma. The normalisation of BP after atrial cannulation was thought to be due to isolation of the tumour from systemic circulation.