Peri-operative management of a child with catecholamine-secreting neuroblastoma and Dravet syndrome undergoing tumour resection.
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Neuroblastoma is the most common extracranial solid tumour in children and accounts for approximately 15% of paediatric cancer-related deaths. Originating from the postganglionic sympathetic nervous system, it exhibits variable clinical behaviour. Catecholamine-secreting neuroblastoma is an uncommon but relevant cause of severe hypertension in children and poses major anaesthetic challenges, particularly during induction and tumour manipulation. Evidence guiding peri-operative blood pressure management in this context remains limited. Dravet syndrome is an encephalopathy characterised by early onset, temperature-sensitive seizures, developmental impairment and drug resistance. Its management requires a tailored anaesthetic approach, as peri-operative factors may lower the seizure threshold. We report the peri-operative management of a 6-year-old child with Dravet syndrome who was diagnosed with a catecholamine-secreting presacral neuroblastoma. Pre-operative optimisation included amlodipine, stepwise α-blockade with phenoxybenzamine, subsequent β-blockade with atenolol and volume expansion. The intra-operative period was complicated by hypertension during tumour resection, preload-related hypotension after prone positioning and hypotension due to arterial bleeding. Postoperatively, antihypertensive therapy was required for several months before discontinuation, and 18 months after the surgery, the child returned to her normal lifestyle. This case combined two high-risk anaesthesia scenarios: catecholamine-mediated haemodynamic instability and a refractory epilepsy syndrome with temperature-sensitive seizures.