Amano A, Shimoda O, Ikuta Y, Terasaki H
Department of Anesthesiology, Kumamoto University School of Medicine, Kumamoto 860-8556.
Masui. 2001 Feb;50(2):192-4.
A 15-year-old girl with history of two cerebral ischemic attacks possibly caused by cerebral vascular spasm was diagnosed as having a pheochromocytoma, and was scheduled for laparoscopic removal of the adrenal tumor. Epidural catheterization was performed at Th 12/L 1. General anesthesia was induced with thiamylal and vecuronium, and maintained with nitrous oxide-oxygen-isoflurane and continuous epidural infusion of 1.5% lidocaine. Phentolamine and thiamylal were continuously administrated into the vein. While operating on the tumor, abnormal hypertension did not occur. Just after removal of the tumor, the systolic blood pressure fell to 50-70 mmHg. The hypotension continued for about 75 min, despite administration of dopamine, norepinephrine and epinephrine. After the emergence from anesthesia, the blood pressure recovered to normal level. No neurocerebral abnormality was found. In patients like this one, we have to prevent cerebral vascular spasm and cerebral infarction caused by excessive secretion of catecholamines.
一名15岁女孩有两次可能由脑血管痉挛引起的脑缺血发作史，被诊断为患有嗜铬细胞瘤，并计划行腹腔镜肾上腺肿瘤切除术。于胸12/腰1行硬膜外导管置入。用硫喷妥钠和维库溴铵诱导全身麻醉，并用氧化亚氮-氧气-异氟烷维持麻醉，并持续硬膜外输注1.5%利多卡因。酚妥拉明和硫喷妥钠持续静脉给药。在切除肿瘤时，未出现异常高血压。刚切除肿瘤后，收缩压降至50 - 70 mmHg。尽管给予多巴胺、去甲肾上腺素和肾上腺素，低血压仍持续约75分钟。麻醉苏醒后，血压恢复到正常水平。未发现神经脑异常。对于这样的患者，我们必须预防由儿茶酚胺过度分泌引起的脑血管痉挛和脑梗死。
