[Sevoflurane with continuous epidural anesthesia for removal of pheochromocytoma].
A 66-year-old female was scheduled for right adrenalectomy because of a pheochromocytoma. Preoperative blood pressure was well controlled with an alpha.beta blocker, amosulalol hydrochloride 40 mg per day po for 2 weeks. The patient received midazolam 2.5 mg im and scopolamine 0.4 mg im 60 minutes before induction. Anesthesia was induced with midazolam 5 mg iv, fentanyl 0.1 mg iv and vecuronium 12 mg iv, and maintained with continuous epidural infusion of 1.5% lidocaine, and inhalation of 66% nitrous oxide in oxygen and sevoflurane (0.5-3%). Blood pressure was controlled with nicardipine (1-6 micrograms.kg-1.min-1) before removal of the pheochromocytoma. After removal of the tumor blood pressure was maintained with intravenous infusion of lactated Ringer's solution, dopamine (3-8 micrograms.kg-1.min-1), dobutamine (3-8 micrograms.kg-1.min-1) and norepinephrine (0.1-0.2 micrograms.kg-1.min-1). A combination of continuous epidural block and sevoflurane anesthesia was very useful for removal of the pheochromocytoma. Swan-Ganz catheter monitoring was also very useful before and during operation to determine the optimal doses of nicardipine, catecholamine and the volume of transfusion.
Department of Anesthesia, Kushiro City General Hospital.
S
S
Tanaka
M
M
Miyabe
I
I
Ohyama
S
S
Seki
T
T
Tsukamoto
A
A
Namiki
D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000368:Aged; D000767:Anesthesia, Epidural; D000769:Anesthesia, Inhalation; D004987:Ethers; D005260:Female; D006801:Humans; D008012:Lidocaine; D008738:Methyl Ethers; D009609:Nitrous Oxide; D010673:Pheochromocytoma / Q000601:surgery*; D000077149:Sevoflurane; D013997:Time Factors
D004987:Ethers; D008738:Methyl Ethers; D000077149:Sevoflurane; D008012:Lidocaine; D009609:Nitrous Oxide