Nitroglycerine in the Anesthetic Management of Pheochromocytoma / 대한마취과학회지

ABSTRACT

A 41 year-old male underwent resection of a pheochromocytoma under general anesthesia. The patient was treated with phenoxybenzamine for 14 days preoperatively and premedicated with triflupromazine, diazepam, pethidine and hydroxyzine in combination. Following induction of anesthesia with intravenous morphine, thiopental sodium and alcuronium, endotracheal intubation was performed. As soon as intubation, tachycardia(143/min) and hypertension(170/100 mmHg) developed, but were controlled by intravenous injection of propranolol. Anesthesia was maintained with nitrous oxide, oxygen and enflurane, and alcuronium. Blood pressure during manupulation of tumor mass was 160/100 mmHg without arrhythmia but gradually was controlled to the range of 120-130/80-85 mmHg after intravenous infuaion of nitroglycerine at the rate of 0.5-2 ug/kg/min. After removal of the tumor mass, the blood pressure dropped to 100/70 mmHg. Blood pressure was controlled by I.V. low molecular weight dextran, and Hartmanns solution, but a vasoconstrictive agent was not needed. There was no marked tachycardia or arrhythmia during anesthesia. The importance of preoperative preparation, premedication, selection of anesthetics and nitroglycerne for controling the episodic hemodynamic pressure response is discussed.