Ip-Yam P C, Ruban P, Cheng C, Ravintharan T
Department of Anaesthesia and Surgical Intensive Care, Singapore General Hospital, Outram Road, Singapore 169608.
Ann Acad Med Singap. 2003 Nov;32(6):828-31.
The laparoscopic adrenalectomy approach to phaeochromocytoma surgery offers the opportunity to use new short-acting drugs to facilitate rapid recovery.
We report on 2 cases who underwent laparoscopic resection of phaeochromocytoma. The first was a 40-year-old lady who had been started on phenoxybenzamine 20 mg bd, but developed a recurrence of bronchial asthma after starting atenolol which was subsequently stopped. The second was a 51-year-old lady with neurofibromatosis who was taking phenoxybenzamine 20 mg bd and propanolol 20 mg tds.
The intraoperative management was facilitated by the stress suppressive effects of remifentanil infusion combined with nitroprusside as a vasodilator, and desflurane as an anaesthetic.
Both patients were extubated at the end of surgery and made uneventful recovery.
Remifentanil possesses several useful properties, which deserve serious consideration in phaeochromocytoma surgery, particularly in the instance where beta-blockade is contraindicated. In combination with other titratable short-acting agents, it potentially facilitates rapid recovery especially following the laparoscopic approach to adrenalectomy.
腹腔镜肾上腺切除术治疗嗜铬细胞瘤为使用新型短效药物促进快速恢复提供了机会。
我们报告2例接受腹腔镜下嗜铬细胞瘤切除术的患者。第一例是一位40岁女性，开始服用苯苄明，每日2次，每次20 mg，但在开始服用阿替洛尔后支气管哮喘复发，随后停用阿替洛尔。第二例是一位51岁患有神经纤维瘤病的女性，正在服用苯苄明，每日2次，每次20 mg以及普萘洛尔，每日3次，每次20 mg。
术中通过输注瑞芬太尼的应激抑制作用联合使用硝普钠作为血管扩张剂以及地氟醚作为麻醉剂，使得手术管理更加便利。
两名患者均在手术结束时拔除气管插管，恢复顺利。
瑞芬太尼具有多种有益特性，在嗜铬细胞瘤手术中值得认真考虑，尤其是在禁忌使用β受体阻滞剂的情况下。与其他可滴定的短效药物联合使用时，它可能有助于快速恢复，特别是在腹腔镜肾上腺切除术之后。
