Anesthetic implications of laparoscopic adrenalectomy in nephrotic syndrome

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 anesthesia implication are special in the presence of long standing essential hypertension and nephrotic syndrome with poly-pharmacy.

To report on the first anesthesia for laparoscopic adrenalectomy Security Forces Hospital (SFH) in Riyadh.

Tertiary care SFH in Riyadh.

A 58 year old Saudi woman diagnosed to have essential hypertension, nephrotic syndrome, NIDDM, and right adrenal tumor, with the provisional diagnosis of pheochromocytoma.

General anesthesia, Thoracic epidural, control of hypertension with both alpha and beta blockers, and selective SICU 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 using epidural narcotics, measurement of blood glucose, blood gases, urea, creatinine and electrolytes. Adequacy of ventilation monitored by capnography and pulse oximetry. The surgical procedure included right adrenalectomy and cholecystectomy.

Anesthesia for laparoscopic adrenalectomy has special problems to solve related to the 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, morbidity and mortality minimal.