Two Case Report on Anesthesia for Pheochromocytoma / 대한마취과학회지

The following is a report of the anesthetic experience in the surgical management of two cases of surgery for pheochromocytoma performed at Maryknoll Hospital, Busan, between the dates of June and July, 1982, The report covers the pre-surgical tests and the laboratory results on the two cases, which was similar, and the anesthetic agents halothane and enflurane, was used on the cases, respectively. During surgery using the anesthetic agent halothane, which was chosen because of the high blood pressure of the patient, and our effect to control it, we encountered dangerous arrythmia. In the case where enflurane was the anesthetic agent uaed, it was found that while the blood pressure of the patient was more difficult to control, the incidence of arrythmias was much less frequent. In one of the cases, becsuse of hemorrhage from the operative site during the immediate surgical period, re-exploration was done with adequate replacement of whole blood and catecholamines administered as needed during the anesthetic management. In comparing the two cases, the one case in which alpha-sdrenergic blockers were not administered during the pre-surgical period, when compared with the case in which the the blockers were used, showed, after removal ef the tumor, a decrease in the need for alpha-adrenergic stimulators.

Halothane Anesthesia for Pheochromocytoma / 대한마취과학회지

Various anesthetic agents have been recommended for pheochromocytoma surgery. However, in general, no ideal anesthetic agent has been accepted as yet. The use of the well known agents, halothane still remains a contraversial issue for pheochromocytoma surgery. According to our experience and a review of the literature, it is strongly suggested that halothane is the anesthetic agent of choice among the anesthetic agents currently available. We believe that the incidence of arrythmia from halothane is not higher than that from other anesthetic agents and arrthmia is not caused primarily by halothane, but results mostly from endogenous catecholamines during surgery. In addition to these advantages, it is a rapid induction agent accompained by a peripheral vessel dilating effect. Lidocaine also is readily available to counteract the disadvantages of the arrythmic effect of halothane. We have had two uneventful cases of pheochromocytoma surgery. One was prepared with phenoxybeaxamine preoperatively and anesthetized with halothane. The other was not prepared with phenoxybeaxamine, but was anesthetized with halothane. The patient prepared with phenoxybeaxamine had prolonged hypotension for two days postoperatively and was treated with Neo-Synephrine drip. However, the patient wihout preoperative phenoxybeaxamine had no problem with his blood pressure post operatively. As a result of this experience, we believe the preoperative use of phenoxybeaxamine is not necessary, plus it also creates more problems with postoperative hypotension. Halothane can act as a vasodilator in place of phenoxybeaxamine during anesthesia. Therefore, halothane is currently the ideal anesthetic agent of choice without phenoxybeaxamine preparation when lidocaine is available.

Anesthetic Experience in Three Patiente with Hurlers Syndrome / 대한마취과학회지

It is well known that many problems occur in patients with Hurler's syndrome both during anesthesia and after. Hurler's syndrome is a mucopolysaccharoidoses characterized by and abnormal metabolism of the mucopolysaccharide. The clinical manifestations include dwarfism, frontal bossing, hypertelorism, thick lips, large tongue, short neck and hepatosplenomegaly. Common complications from anesthesia are excessive secretions, difficult intubation, respiratory and heart failure. Most of the patients die before the age of 10 from pulmonary infection or cardiac failure. In this article, 3 patients anesthetized for surgical intervention are described. Case l: A 10-year old male with Hurler's syndrome was scheduled for umbilical herniorrhaphy. His clinical manifestations included all the typical appearance of the syndrome and large tonsils, excessive secretion, breathing difficulty and mental retardation, etc. Anesthesia was induced with 200mg of pentothal followed by 40 mg of anectin for intubation. The first attempt at endotracheal then a blind awake intubation was performed successfully. Anesthesia was maintained with N20-Halothane. Tracheostomy was performed post-operatively because the breathing became worse. He died of respiratory failure on the 114th post-operative day. Case ll: The patient was 7-year old brother of the above patients, scheduled ofr inguinal herniorrhaphy. Caudal anesthesia was performed with 30cc of 1 percent lidocaine is whole hospitalization was uneventful. Case lll : The above patient was readmitted for umbilical herniorrhaphy on the 9th day after his first operation. He was atropinized preoperatively and anesthesia was induced with 180mg of pentothal followed by Anectin injection for endotracheal intubation .The first attempt failed, then a blind oral intubation was carried out successfully and anesthesia was maintained with N20-Halothane. He recovered from anesthesia with excessive secretion and mild respiratory problems. The problems, complications and precautions for anesthesia are described in this article.