Pheochromocytoma recurrence Anesthesia Analysis o

e707004304 · Wysłany: Wto 1:31, 15 Mar 2011

Pheochromocytoma recurrence Anesthesia: Analysis of 5 Cases

l patients after resection of left and right adrenal gland and 1 case of recurrence times, the bladder in 2 cases of pheochromocytoma resection of the bladder, iliac Apartments and left aortic Youfu each 1 case of recurrence after the first operation recurrence time was 5 years, 7 years,[link widoczny dla zalogowanych], 1.2 years, 1.6 years, 4 years of which 3 cases after the second surgery 1.3 years and 6.2 years. 1.2 years to issue the third surgery. Recurrence of symptoms, such as paroxysmal headache, nausea, vomiting. Blood pressure of up to 25.33 ~ 33.33/12 ~ 25.33kPa urinary catecholamine as 585 ~ 1105g/24h All patients were B-ultrasonography and CT and other tests confirmed tumor. Preoperative oral prazosin 5mg, 3 times / day to control blood pressure and intermittent blood transfusions were 400 ~ 600ml anesthesia options: endotracheal intubation, anesthesia quiet a smoke down 9 times, continuous epidural anesthesia 4 cases. In addition to two down the whole group of malignant pheochromocytoma, but I recovered well 2 discussions and more pheochromocytoma is a benign, can return to work after surgery. . Therefore, the recommended fat pheochromocytoma resection is still necessary. . Recurrent pheochromocytoma of the anesthetic management more difficult, long-term target for the body of these patients repeated the role of high concentrations of catecholamines, a strong contraction of the surrounding blood vessels, increasing peripheral vascular resistance also increased cardiac load. The other hand, high concentrations of catecholamines can directly damage the myocardium, causing myocardial oxygen supply / oxygen demand imbalance, increase of myocardial degeneration, especially catecholamine myocarditis. Therefore, pre-anesthetic preparation is important, this group of patients before surgery phentolamine 0 5 cases of blood pressure with prazosin 8 cases, receive better results. We feel that oral prazosin 5 ~ lOmg, 3 times / day, effective. However, the amount of hours of the antihypertensive effect of the drug prazosin is poor Presynaptic le block the negative feedback regulation by the effect of pensions is very weak, does not increase the release of norepinephrine cable, so the blood pressure is stronger,[link widoczny dla zalogowanych], but no reflex sympathetic obvious excitement, tachycardia and other reactions,[link widoczny dla zalogowanych], but also for the expansion to create the conditions before surgery. The patients were intermittent preoperative blood transfusion 400 ~ 60Oral, all patients anesthesia options, the use of endotracheal intubation, anesthesia quiet a smoke down 9 times, continuous epidural anesthesia 4 down times, we realize endotracheal anesthesia is still safer induction of anesthesia in this group with 25 or thiopental iSml stability and 20mg intravenously, rapidly induced by sodium thiopental, and diazepam on brain between the limbic system and inhibit the sympathetic-adrenal axis activity index also inhibited both can achieve a good sedative, but also increased control of endogenous catecholamines, the role of a good control of blood pressure. On the application of muscle relaxant, succinylcholine should be avoided with the use of tubocurarine in this group and to a bend of the Egyptian can be loose or intravenous succinylcholine to facilitate intubation, and intubation time and relatively abundant. All the patients before intubation, intravenous fentanyl 0.2 ~ 0.3 = ng,[link widoczny dla zalogowanych], can lead to better prevention of cardiovascular response to intubation anesthesia in this group except the maintenance treatment of early cases of inhalation of ether, l, the enflurane j cases where absorption times, isoflurane 4 cases. We feel good isoflurane, cardiac anesthesia drug index for the 5.7, weak inhibition of cardiac output, but also dilation of blood vessels, reducing the role of peripheral resistance and blood pressure, is now the ideal inhaled anesthetic. Expansion surgery is essential, this group of patients before the tumor spider Chen, blood pressure under control Pina average infusion 1500ml, hydroxyl starch 660ml, whole blood 475ml,[link widoczny dla zalogowanych], cutting the average fluid volume after tumor 1640mi, whole blood 800ml. Tumor cut look required norepinephrine to maintain blood pressure in 2 cases, but were removed after surgery J8 hours, all patients except two fell outside coil of malignant pheochromocytoma. I have recovered well.