Anesthetic management of left adrenal myelolipoma posted for left adrenalectomy

Introduction: Adrenal myelolipoma is a rare benign tumor composed of mature lipomatous and hemopoietic tissue. It is often discovered as an incidental finding on imaging of the abdomen for some other reason or at autopsy. These are harmonally inactive. They are associated with a fluctuating clinical course during anaesthesia and surgical intervention. Case report: A 64 year old male patient, ASA Grade II diagnosed to have left adrenal myelolipoma as evidenced by CT scan showing 7.6 X 7.8 X 6cm fat density lesion of left adrenal gland, posted for left adrenalectomy. The physical examination was unremarkable, Laboratory investigations revealed the non-functioning nature of the adrenal mass. Combined general anesthesia and epidural anesthesia was planned. Epidural catheter was inserted. Patient premedicated, sedated and induced. Intra-operative anesthetic management was uneventful except hemodynamic instability which was managed successfully. Patient was extubated after giving adequate reversal. Post-operative period was uneventful and post-operative analgesia was managed by epidural route. Conclusion: The management of patients with Adrenal myelolipoma remains a challenge for the anaesthesiologist. Our role in the successful outcome of such surgeries begins from adequate pre-operative preparation, extensive intra operative monitoring and careful follow up during the post-operative period.