Nitroglycerine in the Anesthetic Management of Pheochromocytoma - Case report / 대한마취과학회지

ABSTRACT

We recently had a patient(51 year-old man) who was to undergo resection of pheochromocytoma under general ansthesia. The patient was treated with phenoxybenzamine for 10 days preoperatively. Following induction of anesthesia with intravenous thiopental sodium, endotracheal intubation was performed with vecuronium and anesthesia was maintained with isoflurane. Following intubation, tachycardia controlled by intravenous injection of small dose of propranolol. The course of anesthesia was rather stormy reflected by hypertension, arrhythmia and hypotension. But the patient tolerated long anesthesia and operation relatively well with appropriate use of nitroglycerine, lidocaine, etc. Importance of preoperative preparation, sufficient sedation, smooth induction, complete analgesia, and good muscular relaxation, adequate alveolar ventilation and stable cardiovascular control has been discussed. Blood pressure during manipulation of tumor was 150/100 mmHg without arrhythmia, but gradually was controlled to the range of 120/80 mmHg after intravenous infusion of nitroglycerine at the rate of 0.5-5 pg/kg/min. To our surprise, the blood pressure and pulse and pulse rate was controlled very well with nitroglycerine and isoflurane. After removal of tumor, the blood pressure dropped 100/70 mmHg, so, blood pressure was controlled by LV fluid(Hartmans dextrose, normal saline, plasmanate, low molecular weight dextran), packed red blood cell, whole blood, fresh frozen plasma, vasopressor of small amount was used. There was no marked hypertension, hypotension, tachycardia, arrhythmia during anesthesia. Thus, we anticipate that nitroglyecerine with beta-blocker may be good intraoperative antihypertensive regimen for pheochromocytoma.