[Anesthetic management of a patient with multiple system atrophy undergoing adrenal gland tumor surgery]

We report anesthetic management of a 61-year-old man with multiple system atrophy undergoing adrenal grand tumor surgery. Before surgery, he was sufficiently hydrated and an elastic bandage had been applied to the legs. After epidural catheterization for the postoperative analgesia, general anesthesia was induced with midazolam 7 mg and remifentanil 0.25 microg x kg(-1) x min(-1) and his trachea was intubated. During surgery, general anesthesia was maintained with sevoflurane and remifentanil 0.12-0.25 microg x kg(-1) x min(-1). Hemodynamics was almost stable although transient hypotension occurred during surgery because of bleeding and partial clamping of the inferior vena cava. After surgery, he emerged from anesthesia and tracheal tube was removed uneventfully. However, on the first postoperative day, hypotension and respiratory failure occurred. Noradrenaline infusion was needed to treat hypotension due to vasodilation and reintubation was performed. After several days, hypotension and respiratory failure improved and he was discharged from ICU.