The Effect of Dopamine on Hepatic Blood Flow in Rabbits Undergoing Thoracic Epidural Anesthesia / 대한마취과학회지

BACKGROUND: Infusion of pentastarch, with or without dopamine, has been used for cardiovascular support during epidural anesthesia, especially for maintaining normotension. The purpose of this study was to evaluate the effects of dopamine on hemodynamics, estimated hepatic blood flow, and the extraction ratio of indocyanine green during thoracic epidural anesthesia with the infusion of pentastarch. METHODS: Thirty healthy rabbits, weighing 2.5 - 3.5 kg, were evenly divided into three groups during thoracic epidural anesthesia; The control group received normal saline (10 ml/kg/hr), the pentastarch group received pentastarch (10 ml/kg/hr), and the dopamine group received pentastarch (10 ml/kg/hr) and a dopamine infusion (5 microgram/kg/min). Thoracic epidural block was done at T5 level with 0.4 ml/kg of 1% lidocaine. Hepatic blood flow was estimated by measuring the clearance of indocyanine green according to the constant infusion method before and 30 and 60 minutes after epidural anesthesia. The extraction ratio of indocyanine green, heart rate, mean arterial pressure, central venous pressure and splanchnic vascular resistance were also measured at the same time in the three groups. RESULTS: Heart rates, mean arterial pressures, estimated hepatic blood flow and splanchnic vascular resistance were unchanged but central venous pressure increased significantly at 30 and 60 minutes after epidural anesthesia in the dopamine group. The extraction ratio of indocyanine green remained unchanged 30 and 60 minutes after epidural anesthesia in all groups. CONCLUSIONS: Combined therapy with pentastarch and dopamine infusion can keep the cardiovascular stability, hepatic blood flow and splanchnic vascular resistance constant during thoracic epidural anesthesia in rabbits.

Anesthetic Management of Pediatric Patient with Pheochromocytoma: A case report / 대한마취과학회지

Pheochromocytoma is an unusual tumor in pediatric age group and there are several different aspects from adult counterparts. Children have fewer malignant, more extra-adrenal, and greater bilaterality and multiplicity of tumor. We present a case of 14-year old boy with pheochromocytoma who has symptoms such as episodic headaches, vomiting, seizure and paroxysmal hypertension which is less common in children. Although the duration of preoperative preparation was not long enough, we decided to remove the tumor because symptoms were disappeared rather rapidly after alpha and beta adrenergic blocker treatment. The patient was managed with continuous epidural block and light general anesthesia but extra use of adrenergic receptor blocker and vasodilator were demanded during tumor manipulation. The patient has remained well postoperatively but long-term follow up is essential because of the possibilities of recurrence.