ABSTRACT
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 microg/kg/min) to prevent and treat marked hemodynamic changes from catecholamine release during tumor manipulation. Hpotension after tumor removal was treated with additional colloids fluids and decreasing the remifentanil infusion rate by 25-50%.
Subject(s)
Adrenal Gland Neoplasms/surgery , Adrenalectomy/methods , Blood Pressure/drug effects , Heart Rate/drug effects , Laparoscopy/methods , Pheochromocytoma/surgery , Piperidines/therapeutic use , Adrenalectomy/adverse effects , Adult , Anesthetics, Inhalation/administration & dosage , Anesthetics, Intravenous/adverse effects , Anesthetics, Intravenous/therapeutic use , Catecholamines/metabolism , Dose-Response Relationship, Drug , Female , Humans , Hypotension/prevention & control , Laparoscopy/adverse effects , Male , Methyl Ethers/administration & dosage , Middle Aged , Neuromuscular Blockade/methods , Nitrous Oxide/administration & dosage , Piperidines/adverse effects , Postoperative Nausea and Vomiting , Prospective Studies , Remifentanil , Sevoflurane , Treatment OutcomeABSTRACT
The aim of this study was the evaluation of the blockade of branches of ophthalmic nerve in the management of the acute attack of migraine headache localized to the ocular region. The study included 70 female patients 23-60 years old who presented to the pain clinic at our hospital with an acute attack of migraine headache localized to the ocular and retro-ocular region. A targeted history and a neurologic examination were performed in all patients to confirm the diagnosis and at the same time to rule out life-threatening neurological dysfunction. The method applied was the blockade of the supraorbital and supratrochlear nerves which are branches of the ophthalmic nerve. By the use of a fine short needle 27G the nerves were sought for until paraesthesia is obtained and then 1 ml of lignocaine 2% with adrenaline 1:200,000 was injected in every one of the three sites of the nerves. The migraine acute attack was relieved in 58/70 patients (82%), while in 12/70 patients (18%) the results were poor. The pain relief started 3-4 min after the injection and was completed in 10-15 min. Our results support that the blockade of the branches of the ophthalmic nerve seems to be a safe and effective technique in the management of the acute attack of migraine localized to the ocular and retro-ocular region.
