title: Dexmedetomidine and remifentanil in the perioperative management of an adolescent undergoing resection of pheochromocytoma -A case report-.
abstract: A 15-year-old adolescent with unilateral multiple adrenal pheochromocytoma had an episode of subcortical intracerebral hemorrhage and seizure 6 weeks before the surgery. He was pretreated with terazosin, losartan, atenolol and levetiracetam for 2 weeks. Dexmedetomidine was started in the preoperative waiting area, and a combination of dexmedetomidine and remifentanil was continuously infused for most of anesthetic time. To control blood pressure, bolus injection of remifentanil and low-dose infusion of sodium nitroprusside, nicardipine, and esmolol were administered during three adrenergic crises. There was minimal post-resection hypotension, and his trachea was extubated safely 20 min after the surgery. He was discharged without noticeable complication. His catecholamine levels showed the steadily decreasing pattern during the operation in this case. Though a combination of dexmedetomidine and remifentanil may not prevent the hemodynamic instability impeccably during the tumor manipulation, this combination seems to be the way of interrupting release of catecholamines and minimizing hemodynamic fluctuations.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea.
authors.forename: Jae-Wook
authors.initials: JW
authors.lastname: Jung
authors.forename: Jung Kyu
authors.initials: JK
authors.lastname: Park
authors.forename: Sang Yoon
authors.initials: SY
authors.lastname: Jeon
authors.forename: Yong Han
authors.initials: YH
authors.lastname: Kim
authors.forename: So-Hyun
authors.initials: SH
authors.lastname: Nam
authors.forename: Young-Gyun
authors.initials: YG
authors.lastname: Choi
authors.forename: Si Ra
authors.initials: SR
authors.lastname: Bang
keywords: Catecholamine; Dexmedetomidine; Pheochromocytoma; Remifentanil