Murakawa T, Kudo T, Kudo M, Matsuki A
Department of Anesthesiology, Odate Municipal Hospital.
Masui. 1994 Oct;43(10):1529-33.
We measured plasma aldosterone, cortisol, ACTH and catecholamine concentrations during removal of aldosterone-producing adrenal tumor under sevoflurane anesthesia in four adult patients. Sevoflurane anesthesia alone did not affect the plasma levels of aldosterone, cortisol, ACTH and catecholamine. Plasma aldosterone levels increased significantly with surgical stimulation and reached the peak value before surgical manipulation. Thereafter they declined in magnitude and reached the value below the peanesthetic levels at recovery from anesthesia. Plasma cortisol and ACTH levels increased significantly with surgical stimulation, and plasma ACTH levels reached the peak values after the emergence from anesthesia in the recovery room. Plasma catecholamine levels increased with surgical stimulation, but the increase in plasma epinephrine levels was more striking than that in plasma norepinephrine levels during surgical manipulation of the tumor. Hypertension during manipulation of the tumor was demonstrated to correlate with increase in plasma epinephrine levels but not with plasma aldosterone levels. Sevoflurane gave us no trouble during anesthetic management for removal of aldosterone-producing adrenal tumor. We conclude that sevoflurane anesthesia is a better choice for surgery for primary aldosteronism.
我们在4例成年患者七氟醚麻醉下切除产生醛固酮的肾上腺肿瘤过程中，测量了血浆醛固酮、皮质醇、促肾上腺皮质激素（ACTH）和儿茶酚胺浓度。单纯七氟醚麻醉不影响血浆醛固酮、皮质醇、ACTH和儿茶酚胺水平。血浆醛固酮水平随手术刺激显著升高，并在手术操作前达到峰值。此后其幅度下降，在麻醉恢复时降至低于麻醉前水平的值。血浆皮质醇和ACTH水平随手术刺激显著升高，血浆ACTH水平在恢复室麻醉苏醒后达到峰值。血浆儿茶酚胺水平随手术刺激升高，但在肿瘤手术操作期间，血浆肾上腺素水平的升高比血浆去甲肾上腺素水平的升高更显著。肿瘤操作期间的高血压被证明与血浆肾上腺素水平升高相关，而与血浆醛固酮水平无关。在用于切除产生醛固酮的肾上腺肿瘤的麻醉管理过程中，七氟醚未给我们带来麻烦。我们得出结论，七氟醚麻醉是原发性醛固酮增多症手术的更好选择。
