Korean J Anesthesiol.  2012 Dec;63(6):555-558. 10.4097/kjae.2012.63.6.555.

Dexmedetomidine and remifentanil in the perioperative management of an adolescent undergoing resection of pheochromocytoma: A case report

• Jung JW
• Park JK
• Jeon SY
• Kim YH
• Nam SH
• Choi YG
• Bang SR

• KMID: 2236259
• DOI: http://doi.org/10.4097/kjae.2012.63.6.555

Abstract

A 15-year-old adolescent with unilateral multiple adrenal pheochromocytoma had an episode of subcortical intracerebral hemorrhage and seizure 6 weeks before the surgery. He was pretreated with terazosin, losartan, atenolol and levetiracetam for 2 weeks. Dexmedetomidine was started in the preoperative waiting area, and a combination of dexmedetomidine and remifentanil was continuously infused for most of anesthetic time. To control blood pressure, bolus injection of remifentanil and low-dose infusion of sodium nitroprusside, nicardipine, and esmolol were administered during three adrenergic crises. There was minimal post-resection hypotension, and his trachea was extubated safely 20 min after the surgery. He was discharged without noticeable complication. His catecholamine levels showed the steadily decreasing pattern during the operation in this case. Though a combination of dexmedetomidine and remifentanil may not prevent the hemodynamic instability impeccably during the tumor manipulation, this combination seems to be the way of interrupting release of catecholamines and minimizing hemodynamic fluctuations.

Keyword

Catecholamine; Dexmedetomidine; Pheochromocytoma; Remifentanil

MeSH Terms

Adolescent
Atenolol
Blood Pressure
Catecholamines
Cerebral Hemorrhage
Dexmedetomidine
Hemodynamics
Humans
Hypotension
Losartan
Nicardipine
Nitroprusside
Pheochromocytoma
Piperidines
Piracetam
Prazosin
Propanolamines
Seizures
Trachea
Atenolol
Catecholamines
Dexmedetomidine
Losartan
Nicardipine
Nitroprusside
Piperidines
Piracetam
Prazosin
Propanolamines