Shapiro J D, el-Ganzouri A, White P F, Ivankovich A D
Department of Anesthesiology, Rush Presbyterian St. Luke's Medical Center, Chicago, Illinois 60612.
Can J Anaesth. 1988 Mar;35(2):190-4. doi: 10.1007/BF03010663.
This is a case report of a 66-year-old patient to whom a combined infusion of midazolam and sufentanil was administered for phaeochromocytoma resection. With the exception of a drop in blood pressure immediately after tumour removal, significant intraoperative haemodynamic stability was observed. There was no need for the intraoperative administration of hypotensive or anti-arrhythmic drugs, nor was any prolonged postoperative anaesthetic effect noted. In this case, the combination of midazolam and sufentanil with N2O:O2 was successful in maintaining cardiovascular stability until the tumour was removed. The consequent drop in blood pressure responded to fluid infusion, a not uncommon event in phaeochromocytoma surgery. Although a prospective randomized study for resection of phaeochromocytoma showed that the choice of the anaesthetic technique is not a crucial factor in determining the patient outcome, we feel this technique of midazolam sufentanil is a worthy alternative to the use of inhalational anaesthetics. The lack of significant myocardial depressive effect of the two drugs, coupled with its simple administration, makes it a useful technique in the anaesthetic management of phaeochromocytoma resection.
这是一例66岁患者的病例报告,该患者在嗜铬细胞瘤切除术中接受了咪达唑仑和舒芬太尼的联合输注。除肿瘤切除后立即出现血压下降外,术中观察到显著的血流动力学稳定性。术中无需使用降压药或抗心律失常药,术后也未观察到任何延长的麻醉效果。在该病例中,咪达唑仑和舒芬太尼与N2O:O2的联合使用成功维持了心血管稳定性直至肿瘤切除。随后的血压下降通过液体输注得到缓解,这在嗜铬细胞瘤手术中并不罕见。尽管一项关于嗜铬细胞瘤切除术的前瞻性随机研究表明,麻醉技术的选择并非决定患者预后的关键因素,但我们认为咪达唑仑舒芬太尼技术是吸入麻醉剂使用的一个有价值的替代方法。这两种药物缺乏显著的心肌抑制作用,加上其给药简单,使其成为嗜铬细胞瘤切除术麻醉管理中的一种有用技术。