Remifentanil in the management of laparoscopic resection of phaeochromocytoma--case reports.

INTRODUCTION

The laparoscopic adrenalectomy approach to phaeochromocytoma surgery offers the opportunity to use new short-acting drugs to facilitate rapid recovery.

CLINICAL PICTURE

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.

TREATMENT

The intraoperative management was facilitated by the stress suppressive effects of remifentanil infusion combined with nitroprusside as a vasodilator, and desflurane as an anaesthetic.

OUTCOME

Both patients were extubated at the end of surgery and made uneventful recovery.

CONCLUSION

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.