Anesthetic Management for Pheochromocytoma with Enflurane ; 2 Cases / 대한마취과학회지

Pheochromocytoma is a functioning tumor occurring in the chromaffin tissue and catecholamines from the tumor cell lead to the symptoms such as hypertension, palpitation and headache. Among the problems arising in the anesthetic management, the excessive secretion of catecholamines by the induction of anesthesia and the tumor mass manipulation causes a hypertensive crisis and the arrhythmia. Also, after the removal of the tumor mass, it must be remembered that a profound hyptension may follow due to abrupt lowering of catecholamine level. We experienced two cases of anesthetic management of pheochromcytoma using enflurane. In one case of sufficient preoperative management, it was performed uneventfully without symptoms such as hypertensive crisis and arrhythmia during the anesthetic management. But, in the other case with insufficient preoperative management, the patient was unstable due to hypertnesive crisis, premature contractions of the ventricle and tachyarrhythmia during the anesthetic management.

Autonomic Hyperreflexia - Case report / 대한마취과학회지

Autonomic hyperreflexia in spinal cord lesion is due to interruption of inhbitory im from higher centers. Especially, dramatic disturbance is seen in cord lesions above the fifth thoracic se and consist of hypertension, bradycardia and sweating. Sometimes marked hypert results in fatal cerebral hemorrhage or subarachnoid hemorrhage ao that the anesthesic gets used to its control and treatment. In current methods of control of hypertension, there are general anesthesia with halothane or enflurane, spinal anesthesia and ganglionic blockers. Ganglionic blockers, such as hexamethonium, drsmatically suppress marked arterial hypertension, also. We have experienced 3 cases of tetraplegic patients. Two cases given local anesthesia developed autonomic hyperreflexia but one case given general anesthesia did not have the hyperreflexia.

Cardiac Arrest after Changing Position / 대한마취과학회지

Positional change under the anesthesia may cause marked hypotension, particularly in the critically ill patient. Therefore, positional change must be accomplished slowly and gently, and blood pressure observed throughout the procedure. Basic components for the safe positioning is knowledge, forethought, teamwork and housekeeping. Patients with paraplegia, quadriplegia, or a critical illness may require intravenous vasopressor drug before turning, and the lightest possible level of anesthesia is used. The authors experienced a case of cardiac arrest after changing position of a paraplegic patient under general anesthesia. The patient was resuscitated.