Key result
Remifentanil fails to prevent hypertensive responses during phaeochromocytoma manipulation while triggering hypotension and bradycardia.
Why the study?
The effects and safety of remifentanil in the anaesthetic management of patients undergoing open adrenalectomy, particularly those receiving alpha- and beta-adrenergic receptor blockers, were not well described.
Does remifentanil prevent hypertensive responses during adrenalectomy in patients with phaeochromocytoma?
Case Report (n=3)
Does remifentanil prevent hypertensive responses during adrenalectomy in patients with phaeochromocytoma?
Remifentanil should be used with caution in phaeochromocytoma patients on alpha- and beta-blockers, as it may cause severe hypotension/bradycardia and does not prevent hypertensive surges during tumour manipulation.
Remifentanil may aid hemodynamic control in adrenalectomy; leaves open safety and efficacy in pheochromocytoma pending controlled trials.
The use of remifentanil has been recommended because of its ability to minimise the hypertensive response to tracheal intubation and surgical stimulation in various types of surgery. We describe the use of remifentanil in the anaesthetic management of three cases of open adrenalectomy, two for removal of a phaeochromocytoma and one for removal of an adrenal cortical tumour. Although the use of remifentanil was associated with no adverse events in the patient undergoing resection of the adrenal cortical tumour, its administration was associated with significant hypotension and bradycardia in the two phaeochromocytoma patients, who had both been given alpha- and beta-adrenergic receptor blocking drugs before surgery. It did not prevent the increases in blood pressure or plasma catecholamine levels associated with tumour manipulation in these patients. Remifentanil should therefore be used with caution in patients receiving alpha- and beta-adrenergic receptor blocking drugs. The use of potent vasodilators may still be necessary during tumour manipulation even if remifentanil is being infused.
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Breslin et al. (2003) conducted a case report in Adrenalectomy (n=3). Remifentanil was evaluated on Haemodynamic response and adverse events. Remifentanil caused significant hypotension and bradycardia in two phaeochromocytoma patients on alpha- and beta-blockers, and failed to prevent hypertensive responses during tumour manipulation.
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