Goal of Study: To prevent marked haemodynamic changes from catecholamine release during laparoscopic adrenalectomy for pheochromocytoma (1).
Material and Methods: After IRB approval nine patients scheduled for laparoscopic adrenalectomy for pheochromocytoma were studied. Preoperatively received α- and β-blockers for 2-3 weeks. Anesthesia was induced with fentanyl/propofol/cis-atracurium maintained with sevoflurane/N2O/O2. A continuous infusion 0.15-0.25 μg/kg/min of remifentanil started immediately after intubation. Central venous catheter and arterial line were inserted. All haemodynamic and ventilatory data were measured and calculated at the following time points: before induction of anesthesia (T0), after induction of anesthesia (T1), with the patient at lateral position (T2), 5 min (T3) and 20 min after insufflation (T4), 5 min before adrenal vein ligation (T5) and 5 min after adrenal vein ligation (T6), after CO2 deflation (T7) and in the recovery room (T8).
Results: Time course of changes in mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP) and infusion rate of remifentanil during pneumoperitoneum and pheochromocytoma resection are shown in the table.
The median consumption of remifentanil per patient throughout the study was 2.3 mg (2.1-5.4 mg).
Conclusion: The use of remifentanil seems to be effective in preventing marked haemodynamic changes from catecholamine release during laparoscopic adrenalectomy for pheochromocytoma.
1 Joris J, Hamoir E et al. Anesth Analg