Joris J L, Hamoir E E, Hartstein G M, Meurisse M R, Hubert B M, Charlier C J, Lamy M L
Department of Anesthesiology and Intensive Care Medicine, University Hospital of Liège, Belgium.
Anesth Analg. 1999 Jan;88(1):16-21. doi: 10.1097/00000539-199901000-00004.
We investigated hemodynamics and plasma catecholamine concentrations in eight consecutive patients undergoing laparoscopic adrenalectomy for suspected pheochromocytoma. The same anesthesia protocol was used in all patients: a continuous infusion of sufentanil 0.5 microg x kg(-1) x h(-1) and isoflurane 0.4% (end-tidal) in 50% N2O/O2. Systolic arterial pressure was maintained between 120 and 160 mm Hg by adjusting an infusion of nicardipine, a calcium-channel blocker, while tachycardia (>100 bpm) was treated by 1-mg boluses of atenolol. Hemodynamics (thermodilution technique) and plasma catecholamine concentrations were measured before surgery, after the induction of anesthesia, after turning the patient to the lateral position, during pneumoperitoneum, during tumor manipulation, after adrenalectomy, and at the end of surgery. Two events resulted in significant catecholamine release: creation of the pneumoperitoneum and adrenal gland manipulation. As a consequence, a twofold increase in cardiac output was recorded. Adjustments of nicardipine infusion (2-6 microg x kg(-1) x min(-1)) minimized changes in mean arterial pressure. Beta-adrenergic blockade was necessary in six patients. In conclusion, laparoscopic adrenalectomy for pheochromocytoma results in marked catecholamine release during pneumoperitoneum and tumor manipulation. Titration of a nicardipine infusion allowed easy and quick control of the hemodynamic aberrancies related to these processes.
Pneumoperitoneum during laparoscopy, now used for adrenalectomy, may complicate anesthetic management of patients with pheochromocytoma. In this study, laparoscopic adrenalectomy was associated with catecholamine release during the creation of pneumoperitoneum and tumor manipulation. Adjustments of a nicardipine infusion readily attenuated the subsequent hemodynamic aberrancies.
我们对连续8例因疑似嗜铬细胞瘤而接受腹腔镜肾上腺切除术的患者的血流动力学和血浆儿茶酚胺浓度进行了研究。所有患者均采用相同的麻醉方案：持续输注舒芬太尼0.5微克·千克⁻¹·小时⁻¹和异氟烷0.4%（呼气末）于50%氧化亚氮/氧气中。通过调整钙通道阻滞剂尼卡地平的输注来维持收缩压在120至160毫米汞柱之间，而心动过速（>100次/分钟）则用1毫克剂量的阿替洛尔治疗。在手术前、麻醉诱导后、患者转为侧卧位后、气腹期间、肿瘤操作期间、肾上腺切除术后以及手术结束时测量血流动力学（热稀释技术）和血浆儿茶酚胺浓度。有两个事件导致了显著的儿茶酚胺释放：气腹的建立和肾上腺的操作。结果，心输出量记录增加了两倍。调整尼卡地平输注（2 - 6微克·千克⁻¹·分钟⁻¹）可使平均动脉压的变化最小化。6例患者需要使用β - 肾上腺素能阻滞剂。总之，腹腔镜肾上腺切除术治疗嗜铬细胞瘤在气腹和肿瘤操作期间会导致显著的儿茶酚胺释放。滴定尼卡地平输注可轻松快速地控制与这些过程相关的血流动力学异常。
目前用于肾上腺切除术的腹腔镜气腹可能会使嗜铬细胞瘤患者的麻醉管理复杂化。在本研究中，腹腔镜肾上腺切除术与气腹建立和肿瘤操作期间的儿茶酚胺释放有关。调整尼卡地平输注可轻易减轻随后的血流动力学异常。
