Remifentanil preventing hemodynamic changes during laparoscopic adrenalectomy for pheochromocytoma

In this prospective case-series study, a balanced anesthetic scheme of sevoflurane in nitrous oxide supplemented with remifentanil and sustained neuromuscular block was applied in nine patients scheduled for laparoscopic adrenalectomy for pheochromocytoma. Laparoscopic adrenalectomy to treat pheochromocytoma results in marked catecholamine release during pneumoperitoneum and tumor manipulation. Remifentanil infusion was adjusted to maintain systolic arterial pressure between 120-170 mmHg. Increased infusion rate of remifentanil was used [up to 3 ug/kg/min] to prevent and treat marked hemodynamic changes from catecholamine release during tumor manipulation. Hypotension after tumor removal was treated with additional colloids fluids and decreasing the remifentanil infusion rate by 25-50%

intubating laryngeal mask airway fastrach[trade mark] for emergence after carotid endarterectomy

We determine the feasibility of using the intubating laryngeal mask airway Fastradh [trade mark] [ILM] as a ventilatory device during emergence from anesthesia after use as an airway intubator in patients undergoing carotid endarterectomy. Thirty-five patients [ASA 2-3, 53-84 yr] were studied. Induction was with midazolam/fentanyl/etomidate and maintenance was with sevoflurane 1-2% in O[2] 33-50% and N[2]O. Neuromuscular blockade was with cisatracurium. Tracheal intubation was with a flexible lightwand via the ILM. After successful intubation, the ILM remained in the pharynx, but with the cuff deflated. After surgery, but before anesthesia was discontinued, baseline cardiovascular variables were recorded. The ILM cuff was then reinflated, the tracheal tube removed, the anesthesia breathing system connected to the ILM and anesthesia discontinued. Any changes in the cardiovascular variables greater than +/- 20% baseline values were noted from cuff reinflation to 1 minute after ILM removal. Any adverse respiratory [laryngospasm, coughing, gagging, stridor, SpO2 <94%, end-tidal carbon dioxide >45 mmHg, regurgitation/aspiration] or electrocardiographic [ST segment or rhythm changes] events were also noted. Patients were questioned about postoperative sore throat at 2 and 24 hr. ILM insertion and intubation through the ILM were successful in all patients. Adequate ventilation was achieved in all patients before intubation and after extubation. The mean [range] time taken from cuff reinflation to ILM removal was 9 [5-21] min. The rate pressure product remained within +/- 20% baseline values in all patients. There were no adverse respiratory or electrocardiographic events. There were no adverse neurological events. The surgical field was satisfactory. Postoperative sore throat occurred in 14% at 2 hr and 0% at 24 hr. We conclude that the ILM can be used as a ventilator device for emergence from anesthesia after use as an airway intubator for carotid endarterectomy