Clinical Evaluation of Anesthetic Management for Pheochromocytoma Following Prazosin Pre-treament / 대한마취과학회지

Perioperative management of patients with pheochromocytoma is challenging. Accordingly, proper preoperative preparation is important. Prazosin, a selective alpha I blocker, may offer a potential advantage. This 54-year-old woman was treated with prazosin 2 mg, b.i.d. for 15 days and also with propranolol 20 mg, b.i.d. for a few days intermittently before the proposed surgery. Both symptoms and blood pressure were well controlled effectively. Induction of anesthesia was accomplished with nitrolingual spray, fentanyl 100 ug, 1% idocaine 50 mg, 2.5% thiopental sodium 200 mg, vecuronium 6 mg and 100% O2-enflurane. During the surgical and anesthetic procedure, the patient showed a reduced incidence of excessive blood-pressure variations and no arrhythmia was present except for supraventricular ectopic beats. Conclusively, we believe that careful preoperative preparation is recommended to minimize intraoperative hemodynamic dieturbances and their sequelae.

Intraoperative Thrombelastographic ( TEG ) Monitoring and Treatment of Massive Transfused Patients / 대한마취과학회지

We have 3 more cases of experiences of massive transfusion undergoing hepatobiliary surgery above 20 units of whole blood, packed RBCs, FFP or cryoprecipitate under thrombelastographic guidance and monitoring intraoperatively. One of them had been transfused with 98 units of whole blood and 16 units of PRBC during a couple of times operation without any post-massive transfused pulmonary complications. TEG was originally developed by Hartert in 1948 but its clinical use has been limited. Recently as increases of severe and persistent coagulopathy that accompanies end-stage liver diseases and leads to massive intraoperatve bleeding, minute-to-minute monitoring of the coagulation system is mandatory for successful completion of surgery and for patient survival. Under the condition of our clinical experiences TEG appears to be a very effective method of monitoring blood coagulation. First, blood coagulabilty can be observed rapidly and simply in acute clinical situations within 30 minutes. Second, it assesses the quality of blood clot including the influence of cellular and humoral elements and pathologic conditions. The last, under the reliable guidance of TEG we could facilitate the segmental blood transfusion rather than using whole blood intraoperatively and it is to be a moment of the development of PRBC transfusion set by Kim et al.