Tanaka S, Miyabe M, Ohyama I, Seki S, Tsukamoto T, Namiki A
Department of Anesthesia, Kushiro City General Hospital.
Masui. 1991 Aug;40(8):1261-4.
A 66-year-old female was scheduled for right adrenalectomy because of a pheochromocytoma. Preoperative blood pressure was well controlled with an alpha.beta blocker, amosulalol hydrochloride 40 mg per day po for 2 weeks. The patient received midazolam 2.5 mg im and scopolamine 0.4 mg im 60 minutes before induction. Anesthesia was induced with midazolam 5 mg iv, fentanyl 0.1 mg iv and vecuronium 12 mg iv, and maintained with continuous epidural infusion of 1.5% lidocaine, and inhalation of 66% nitrous oxide in oxygen and sevoflurane (0.5-3%). Blood pressure was controlled with nicardipine (1-6 micrograms.kg-1.min-1) before removal of the pheochromocytoma. After removal of the tumor blood pressure was maintained with intravenous infusion of lactated Ringer's solution, dopamine (3-8 micrograms.kg-1.min-1), dobutamine (3-8 micrograms.kg-1.min-1) and norepinephrine (0.1-0.2 micrograms.kg-1.min-1). A combination of continuous epidural block and sevoflurane anesthesia was very useful for removal of the pheochromocytoma. Swan-Ganz catheter monitoring was also very useful before and during operation to determine the optimal doses of nicardipine, catecholamine and the volume of transfusion.
一名66岁女性因嗜铬细胞瘤计划行右肾上腺切除术。术前血压通过α、β受体阻滞剂盐酸阿罗洛尔每天口服40mg，持续2周得到良好控制。患者在诱导前60分钟接受咪达唑仑2.5mg肌肉注射和东莨菪碱0.4mg肌肉注射。麻醉诱导采用静脉注射咪达唑仑5mg、芬太尼0.1mg和维库溴铵12mg，并通过持续硬膜外输注1.5%利多卡因以及吸入66%氧化亚氮和七氟醚（0.5 - 3%）维持。在切除嗜铬细胞瘤前，血压用尼卡地平（1 - 6微克·千克⁻¹·分钟⁻¹）控制。切除肿瘤后，通过静脉输注乳酸林格氏液、多巴胺（3 - 8微克·千克⁻¹·分钟⁻¹）、多巴酚丁胺（3 - 8微克·千克⁻¹·分钟⁻¹）和去甲肾上腺素（0.1 - 0.2微克·千克⁻¹·分钟⁻¹）维持血压。持续硬膜外阻滞和七氟醚麻醉联合应用对切除嗜铬细胞瘤非常有用。在手术前和手术期间，Swan - Ganz导管监测对于确定尼卡地平、儿茶酚胺的最佳剂量以及输血量也非常有用。
