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

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.

Effects of an Early Intensive Blood Pressure–lowering Strategy Using Remifentanil and Dexmedetomidine in Patients with Spontaneous Intracerebral Hemorrhage: A Multicenter, Prospective, Superiority, Randomized Controlled Trial

“…31,36 Studies have indicated that continuous infusion of remifentanil and dexmedetomidine could maintain hemodynamic stability, including heart rate and blood pressure. [37][38][39] Additionally, this combination strategy 18 [8,33] 0.218 − 16 [8,30] 18 [8,33] 0.211 − 16 [8,28] 18 [9,33] 0…”

“…31,36 Studies have indicated that continuous infusion of remifentanil and dexmedetomidine could maintain hemodynamic stability, including heart rate and blood pressure. 37–39 Additionally, this combination strategy reduces the dose dependence of calcium channel blockers like nimodipine by attenuating the sympathetic response. 40 This establishes a scientific foundation for the integrated approach and elucidates why this strategy could contribute to early intensive blood pressure–lowering.…”

Dexmedetomidine for anaesthetic management of phaeochromocytoma in a child with von Hippel-Lindau type 2 syndrome

“…[ 4 ] The use of dexmedetomidine and remifentanil for an adolescent undergoing resection of phaeochromocytoma has been successfully reported by Jung et al . [ 5 ] Dexmedetomidine and sevoflurane were successfully used by Khetarpal et al . in an adult undergoing resection of phaeochromocytoma.…”

Anaesthetic management of a dog undergoing unilateral adrenalectomy for phaeochromocytoma excision using a partial intravenous anaesthetic protocol

“…Its sympatholytic properties ( Gertler et al ., 2001 ) render this agent attractive for the anesthetic management of phaeochromocytoma resection. While its use as an intraoperative constant rate infusion (CRI) has been described in humans ( Wong and Cheung, 2004 ; Bryskin and Weldon, 2010 ; Schumann and Hudcova, 2010 ; Jung et al ., 2012 ; Khetarpal et al ., 2014 ; Ali Erdogan et al ., 2015 ; Dias et al ., 2015 ; Hedge et al ., 2016 ; Shrestha et al ., 2016 ; Giordano et al ., 2019 ; ), concomitant vasodilators were still frequently needed during surgical manipulation. There is, to date, a single case report of its perioperative use for phaeochromocytoma removal in a canine patient ( Viilmann and Vettorato, 2021 ).…”