Laparoscopic Adrenalectomy In A Patient With Nephrotic Syndrome

摘要

During the last two decades laparoscopic surgery has become a widely practiced procedure. Laparoscopic adrenalectomy for adrenal tumor excision is one of these new applications, The Anaesthesia related implications are critical and note-worthy in the presence of long standing essential hypertension and nephrotic syndrome with poly-pharmacy. OBJECTIVES: To report the first anesthesia for laparoscopic adrenalectomy in Security Forces Hospital in Riyadh. SETTING: Tertiary Care Security Forces Hospital in Riyadh. PATIENT: A 58 years old Saudi woman diagnosed with essential hypertension, nephrotic syndrome, non insulin dependent diabetes mellitus (NIDDM), and right adrenal tumor, with the provisional diagnosis of pheochromocytoma. INTERVENTIONS: General anesthesia, thoracic epidural, control of hypertension with both alpha and beta blockers, and selective Surgical ICU admission for monitoring and pain relief. MEASUREMENT AND THE MAIN RESULTS: Preoperative ultrasound and MRI, MIBG scan of the adrenals, catecholamines serum level, intraoperative direct cardiovascular pressure measurements using Swan-Ganz catheter and arterial line. Pain control was achieved by using epidural narcotics, measurement of blood glucose, blood gases, urea, creatinine and electrolytes. Adequacy of ventilation was monitored by capnography and pulse oximetry. The surgical procedures included right adrenalectomy and cholecystectomy. CONCLUSION: Anaesthesia for laparoscopic adrenalectomy has special problems to be solved specially in relation to pneumoperitonium effect, poly-pharmacy and the current disease state. The use of modern anesthetic agents, cardiovascular monitoring, ventilation and proper analgesia make the hospital stay short, thus ensuring low morbidity and minimal mortality.