Remifentanil in the Management of Laparoscopic Resection of Phaeochromocytoma - Case Reports

Abstract

Introduction: The laparoscopic adrenalectomy approach to phaeochromocytoma surgery offers the opportunity to use new short-acting drugs to facilitate rapid recovery. Clinical Picture: We report on 2 cases who underwent laparoscopic resection of phaeochromocytoma. The first was a 40-year-old lady who had been started on phenoxybenzamine 20 mg bd, but developed a recurrence of bronchial asthma after starting atenolol which was subsequently stopped. The second was a 51-year-old lady with neurofibromatosis who was taking phenoxybenzamine 20 mg bd and propanolol 20 mg tds. Treatment: The intraoperative management was facilitated by the stress suppressive effects of remifentanil infusion combined with nitroprusside as a vasodilator, and desflurane as an anaesthetic. Outcome: Both patients were extubated at the end of surgery and made uneventful recovery. Conclusion: Remifentanil possesses several useful properties, which deserve serious consideration in phaeochromocytoma surgery, particularly in the instance where β-blockade is contraindicated. In combination with other titratable short-acting agents, it potentially facilitates rapid recovery especially following the laparoscopic approach to adrenalectomy.