Remifentanil preventing hemodynamic changes during laparoscopic adrenalectomy for pheochromocytoma.
In this prospective case-series study, a balanced anesthetic scheme of sevoflurane in nitrous oxide supplemented with remifentanil and sustained neuromuscular block was applied in nine patients scheduled for laparoscopic adrenalectomy for pheochromocytoma. Laparoscopic adrenalectomy to treat pheochromocytoma results in marked catecholamine release during pneumoperitoneum and tumor manipulation. Remifentanil infusion was adjusted to maintain systolic arterial pressure between 120-170 mmHg. Increased infusion rate of remifentanil was used (up to 3 microg/kg/min) to prevent and treat marked hemodynamic changes from catecholamine release during tumor manipulation. Hpotension after tumor removal was treated with additional colloids fluids and decreasing the remifentanil infusion rate by 25-50%.
Dimitriou
V
V
Department of Anaesthesia, G Genimmatas General Hospital of Athens, Athens, Greece. vaskdimi@otenet.gr
Chantzi
C
C
Zogogiannis
I
I
Atsalakis
J
J
Stranomiti
J
J
Varveri
M
M
Malefaki
A
A
D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000009:adverse effects / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D002395:Catecholamines / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D007022:Hypotension / Q000517:prevention & control; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D008875:Middle Aged; D019148:Neuromuscular Blockade / Q000379:methods; D009609:Nitrous Oxide / Q000008:administration & dosage; D010673:Pheochromocytoma / Q000601:surgery*; D010880:Piperidines / Q000009:adverse effects / Q000627:therapeutic use*; D020250:Postoperative Nausea and Vomiting; D011446:Prospective Studies; D000077208:Remifentanil; D000077149:Sevoflurane; D016896:Treatment Outcome
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D002395:Catecholamines; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D009609:Nitrous Oxide; D000077208:Remifentanil