Middle East journal of anaesthesiology
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Middle East J Anaesthesiol · Feb 2004
ReviewPerioperative management of the patient undergoing vascular surgery.
Providing optimal perioperative care to the patient undergoing vascular surgery is a continuum; it starts with an accurate preoperative identification and management of the associated comorbidities, evolves into an adapted selection of the level of intraoperative monitoring and the anesthetic technique, and implies an extension of the vigilant care into the postoperative period. The perioperative consultants, the anesthesiologists, and the surgeons should combine their efforts to accomplish this challenging task. Also, they should continuously upgrade their skills to cope with the development of new techniques, such as endovascular repairs, that may minimize postoperative morbidity.
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Middle East J Anaesthesiol · Feb 2004
Case ReportsRemifentanil for modulation of hemodynamics in a patient undergoing laparoscopic resection of pheochromocytoma.
The present report monitors the hemodynamic fluctuations in a 63 year-old female patient undergoing laparoscopic resection of right adrenal pheochromocytoma during remifentanil-based anesthesia. Anesthesia was induced with lidocaine 1 mg x kg(-1), propofol 3.5 mg x kg(-1), and cisatracurium 0.2 mg(-1) x kg(-1) and a remifentanil infusion was started at a rate of 1 ug.kg (-1) x min(-1). Anesthesia was then maintained with remifentanil infusion (0.5 microg(-1) x kg(-1) x min), sevoflurane 1-2% (end-tidal) in a mixture of air/oxygen (3:1), and a continuous infusion of cisatracurium. ⋯ Ten min after removal of the tumor, and despite discontinuation of the NTG infusion as well as a reduction in the remifentanil infusion and sevoflurane concentration, the BP decreased down to 64/43 mmHg. In conclusion, the present report shows in a patient undergoing laparoscopic resection of adrenal pheochromocytoma that remifentanil does not prevent the severe hypertensive episodes associated with intraperitoneal carbon dioxide insufflation or tumor manipulation. However, it can be titrated to prevent the hemodynamic reflex response to tracheal intubation and surgical stimulation.