Anesthetic Management of Laparoscopic Resection of Adrenal Pheochromocytoma

• Published in: Nihon Rinshō Masui Gakkai shi Vol. 15; no. 4; pp. 341 - 345
• Main Authors: KOBAYASHI, Yasuo, SEKI, Sumihiko, YAMAZAKI, Yutaka, SONODA, Hajime, KAWANA, Shin, NAMIKI, Akiyoshi
• Format: Journal Article
• Language: English
• Published: THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA 1995
• ISSN: 0285-4945; 1349-9149
• DOI: 10.2199/jjsca.15.341

A 47-year-old male was scheduled for laparoscopic resection of adrenal pheochromocytoma. Although serum concentrations of norepinephrine and epinephrine were high, paroxysmal hypertension and tachycardia were well controlled by prazosin and metoprolol preoperatively. Following premedication with midazolam and scopolamine, an epidural tube was inserted via T11-12. Anesthesia was induced by midazolam and fentanyl and then maintained by a combination of sevoflurane, fentanyl and continuous epidural anesthesia. Although laparoscopic adrenectomy was conducted to reduce surgical stress, the operation required 6.5 hours due to a limited view and surgical manipulation, and serum concentration of catecholamines increased. Hemodynamic changes induced by surgical manipulation could be controlled well by increasing sevoflurane concentration, and by administering nicardipine, nitroglycerine and propranolol. Catecholamine substitution was not necessary during the operation. The patient recovered uneventfully and was discharged nine days after the operation. A combination of sevoflurane, fentanyl, and continuous epidural anesthesia was shown to be suitable for this long operation.