Summary
From our experience, the following are important requirements in the successful management of pheochromocytoma cases. ( 1 ) Adequate hospital treatment with the blocking agents for at least one week prior to surgery. (2) Adequate blood replacement during surgery, and preoperatively if necessary. (3) Adequate cortisone before, during, and after surgery. (4) Our anaesthetic of choice is thiopentone, opiate, nitrous oxide, with succinylcholine for relaxation, and controlled respiration. Careful monitoring of the blood pressure, central venous pressure, and electrocardiograph are mandatory.
The general surgical mortality rate reported elsewhere for the period 1952–65 was thirteen per cent.4 There were no deaths in our series. We predict that in the future this operation will be a relatively safe procedure. The knowledge, diagnostic investigation, and therapeutic drugs at our command are available to accomplish this.
RéSUMé
Au cours des dix dernières années à l’Hôpital Général de Vancouver, on a pratiqué chez sept malades treize anesthésies pour l’ablation de dix phéochromocytomes. Un malade à sa troisième opération avait des métastases multiples. On expose l’usage de différents médicaments et de techniques variées d’anesthésie. Les points importants qui assurent le succès dans le traitement de ces malades sont: (1) Soins appropriés à l’hôpital durant au moins une semaine avant l’opération: agents bloqueurs de récepteurs alpha et, s’il y a indication, agents bloqueurs de récepteurs bêta; cependant l’utilité de ces derniers n’a pas été etablie de façon évidente. (2) Remplacement du sang de façon minutieuse durant l’opération, et si nécessaire avant l’opération pour établir le volume sanguin normal. (3) Traitement adéquat à la Cortisone avant, pendant et après l’intervention. (4) Pour l’ablation chirurgicale, notre choix d’anesthésique est pentothal, opiacés, protoxyde d’azote, succinylcholine comme agent myorésolutif et respiration contrôlée. Le milieu physique doit être maintenu aussi normal que possible. II est essentiel d’enregistrer attentivement la pression artérielle, la pression veineuse centrale, l’éctrocardiogramme.
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Engelbrecht, E.R., Hugill, J.T. & Graves, H.B. Anaesthetic management of pheochromocytoma. Can. Anaes. Soc. J. 13, 598–606 (1966). https://doi.org/10.1007/BF03002229
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DOI: https://doi.org/10.1007/BF03002229