Midazolam-sufentanil anaesthesia for phaeochromocytoma resection. 1988

J D Shapiro, and A el-Ganzouri, and P F White, and A D Ivankovich
Department of Anesthesiology, Rush Presbyterian St. Luke's Medical Center, Chicago, Illinois 60612.

This is a case report of a 66-year-old patient to whom a combined infusion of midazolam and sufentanil was administered for phaeochromocytoma resection. With the exception of a drop in blood pressure immediately after tumour removal, significant intraoperative haemodynamic stability was observed. There was no need for the intraoperative administration of hypotensive or anti-arrhythmic drugs, nor was any prolonged postoperative anaesthetic effect noted. In this case, the combination of midazolam and sufentanil with N2O:O2 was successful in maintaining cardiovascular stability until the tumour was removed. The consequent drop in blood pressure responded to fluid infusion, a not uncommon event in phaeochromocytoma surgery. Although a prospective randomized study for resection of phaeochromocytoma showed that the choice of the anaesthetic technique is not a crucial factor in determining the patient outcome, we feel this technique of midazolam sufentanil is a worthy alternative to the use of inhalational anaesthetics. The lack of significant myocardial depressive effect of the two drugs, coupled with its simple administration, makes it a useful technique in the anaesthetic management of phaeochromocytoma resection.

UI MeSH Term Description Entries
D008874 Midazolam A short-acting hypnotic-sedative drug with anxiolytic and amnestic properties. It is used in dentistry, cardiac surgery, endoscopic procedures, as preanesthetic medication, and as an adjunct to local anesthesia. The short duration and cardiorespiratory stability makes it useful in poor-risk, elderly, and cardiac patients. It is water-soluble at pH less than 4 and lipid-soluble at physiological pH. Dormicum,Midazolam Hydrochloride,Midazolam Maleate,Ro 21-3981,Versed,Hydrochloride, Midazolam,Maleate, Midazolam,Ro 21 3981,Ro 213981
D010673 Pheochromocytoma A usually benign, well-encapsulated, lobular, vascular tumor of chromaffin tissue of the ADRENAL MEDULLA or sympathetic paraganglia. The cardinal symptom, reflecting the increased secretion of EPINEPHRINE and NOREPINEPHRINE, is HYPERTENSION, which may be persistent or intermittent. During severe attacks, there may be HEADACHE; SWEATING, palpitation, apprehension, TREMOR; PALLOR or FLUSHING of the face, NAUSEA and VOMITING, pain in the CHEST and ABDOMEN, and paresthesias of the extremities. The incidence of malignancy is as low as 5% but the pathologic distinction between benign and malignant pheochromocytomas is not clear. (Dorland, 27th ed; DeVita Jr et al., Cancer: Principles & Practice of Oncology, 3d ed, p1298) Pheochromocytoma, Extra-Adrenal,Extra-Adrenal Pheochromocytoma,Extra-Adrenal Pheochromocytomas,Pheochromocytoma, Extra Adrenal,Pheochromocytomas,Pheochromocytomas, Extra-Adrenal
D005260 Female Females
D005283 Fentanyl A potent narcotic analgesic, abuse of which leads to habituation or addiction. It is primarily a mu-opioid agonist. Fentanyl is also used as an adjunct to general anesthetics, and as an anesthetic for induction and maintenance. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1078) Phentanyl,Duragesic,Durogesic,Fentanest,Fentanyl Citrate,Fentora,R-4263,Sublimaze,Transmucosal Oral Fentanyl Citrate,R 4263,R4263
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000310 Adrenal Gland Neoplasms Tumors or cancer of the ADRENAL GLANDS. Adrenal Cancer,Adrenal Gland Cancer,Adrenal Neoplasm,Cancer of the Adrenal Gland,Neoplasms, Adrenal Gland,Adrenal Cancers,Adrenal Gland Cancers,Adrenal Gland Neoplasm,Adrenal Neoplasms,Cancer, Adrenal,Cancer, Adrenal Gland,Cancers, Adrenal,Cancers, Adrenal Gland,Neoplasm, Adrenal,Neoplasm, Adrenal Gland,Neoplasms, Adrenal
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D000771 Anesthesia, Intravenous Process of administering an anesthetic through injection directly into the bloodstream. Anesthesias, Intravenous,Intravenous Anesthesia,Intravenous Anesthesias
D000777 Anesthetics Agents capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general ANESTHESIA, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. Anesthetic,Anesthetic Agents,Anesthetic Drugs,Anesthetic Effect,Anesthetic Effects,Agents, Anesthetic,Drugs, Anesthetic,Effect, Anesthetic,Effects, Anesthetic
D017409 Sufentanil An opioid analgesic that is used as an adjunct in anesthesia, in balanced anesthesia, and as a primary anesthetic agent. R-30730,Sufenta,Sufentanil Citrate,Sufentanil Curasan,Sufentanil-Hameln,Sufentanil-Ratiopharm,Sulfentanil,Sulfentanyl,Citrate, Sufentanil,Curasan, Sufentanil,R 30730,R30730,Sufentanil Hameln,Sufentanil Ratiopharm,SufentanilHameln,SufentanilRatiopharm

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