Anesthetic technique in surgery for pheochromocytoma presents well recognized difficulties. Major complications (hypertensive crises, rhythm disturbances, collapse, pulmonary edema and hypoglycemia) can often be avoided by a good preoperative examination and full per-operative monitoring. The choice of drugs during anesthesia and per-operative resuscitation are discussed in this article together with particular situations such as pheochromocytoma in pregnancy or the per-operative discovery of a previously unrecognized pheochromocytoma.

Adrenal Gland Neoplasms↗

PubMed1988

A comparison between propofol and ketamine for anaesthesia in the elderly. Haemodynamic effects during induction and maintenance.

The haemodynamic effects of propofol and ketamine were studied in two groups of eight randomly allocated elderly patients (mean age 85.8 years) anaesthetised for hip replacement. Group 1 patients patients received propofol 1 mg/kg by intravenous bolus for induction and 0.1 mg/kg/minute by continuous infusion for maintenance. Group 2 patients received ketamine 1.5 mg/kg by intravenous bolus as induction dose and 50 micrograms/kg/minute by continuous infusion for maintenance. All patients breathed spontaneously via a facemask at FIO2 1.0. Haemodynamic status was established before induction and at 1, 3, 5, 10 and 15 minutes after induction. Arterial pressure and cardiac output decreased slightly in group 1 but heart rate, right atrial pressure and pulmonary arterial pressure remained unchanged. Myocardial oxygen consumption showed a significant decrease of 27%. There was a significant increase in blood pressure and pulmonary capillary wedge pressure (by 97%) in group 2. Cardiac output and systemic vascular resistance remained unchanged whereas myocardial oxygen consumption showed a very significant increase of 100%.

Aged↗

PubMed1987

[Propofol or ketamine in anesthesia of the very old patient. Study of the hemodynamic effects during induction].

The haemodynamic changes following anaesthesia for hip surgery in 16 very old ASA II or III patients (mean age 85.8 +/- 5 years) were studied. Patients were randomly assigned to two groups: group I 1 mg X kg-1 propofol, group II 1.5 mg X kg-1 ketamine. After injection, the patients were left spontaneously breathing oxygen, and were assisted when apneic. Haemodynamic measures with a Swan-Ganz catheter and thermodilution cardiac output calculator were made before and 1, 3, 5, 10 and 15 min after anaesthetic induction. The two groups were similar in age, weight and mean arterial pressure, but statistically different for some haemodynamic parameters (Ppa, Ppw, CI). In group I, arterial pressure fell significantly (-17%) in the first minute and continued to fall (-15%) until the 15th min. Heart rate remained unchanged: right atrial and pulmonary pressures were not changed; cardiac index fell slightly and MVO2 estimated by the triple product fell (-27%) as soon as propofol was infused. There was no clinical sign of cardiac failure. In group II, arterial pressure increased significantly, and heart rate decreased; pulmonary capillary wedge pressure increased (+93% after the 3rd min) and cardiac index was unchanged. The ventricular function curve was shifted to the right, suggesting a decrease in inotropism. Systemic vascular resistances were steady. MVO2 increased twofold, mainly due to the rise in pulmonary capillary wedge pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1987

[Hemodynamic changes induced by ketamine anesthesia in the very old patient].

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Aged↗

PubMed1987

[Value of propofol in microsurgery of the middle ear].

In 21 anaesthetics on patients ASA I-II undergoing middle ear microsurgery, the induction was done by 2 mg/kg propofol and 2 mcg/kg fentanyl. Anaesthesia was maintained by a continuous infusion of propofol 100 mcg/kg/min and bolus injections of fentanyl 1 mcg/kg every 30 min, and controlled ventilation with 60% Nitrous Oxide. The side effects during induction and recovery were minor. After a slight fall in blood pressure at induction, the haemodynamic values were steady during the whole surgery. Haemostasis was always good: the operating field was bloodless in 13 patients (62%), relatively bloody in 8 (38%), but never inconvenient for the surgeon. While recovery happened later than in other studies, the time from eyes opening to complete consciousness was always short, less than 10 minutes. The adjunction of fentanyl could be responsible for the long recovery time. No correlation is found between the infusion rate of propofol and recovery time. All patients but one are satisfied with their anaesthesia, especially with their smooth recovery.

Adolescent↗