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• W2078359296 abstract "D URING the past severa years adrenaIectomy has been advocated as a means of treating advanced disseminated carcinomatosis, particuIarly that stemming from maIignant disease of the breast and prbstate. This report is limited to our experience with fifteen patients with mammary carcinoma, upon whom twentynine individua1 operations were performed. Metastases usuaIIy invoIved the Iungs, skeIeta1 system, skin, Iymph nodes, Iiver, brain, ovaries and adrena gIands. The inter-reIated effects on metastatic growth and extension of ovarian, pituitary and adrena cortica1 secretions have been we11 estabIished and afford a IogicaI basis for the operation. The resuIts of oophorectomy and adrenaIectomy on patients with mammary carcinoma have been evaIuated and documented [1,2,6,7], but there is IittIe information in the Iiterature [3--f] reIevant to their anesthetic management. It is abundantIy cIear that medica teamwork pIays an important roIe in the management of these patients. Proper preparation for surgery by the endocrinologist, skiIIfu1 handIing by the anesthesiologist and surgeon during the operation, and vigilant postoperative care are a11 essentia1. Patients undergoing oophorectomy and adrenaIectomy for carcinomatosis are among the poorest risks coming to surgery. Because vita1 organs have usuaIIy been invoIved by metastatic growth, the patients’ abiIity to react to stress has been greatIy impaired and there is dif3cuIty in breathing deepIy after operation. ConsequentIy, the procedure was generaIIy carried out in two stages in our series. BiIateraI oophorectomy and uniIatera1 adrenaIectomy usuaIIy were performed in the first stage, and the second adrena gIand was removed seven to ten days later. Oophorectomy and left adrenaIectomy were performed in the first operation on thirteen of our patients, right adrenaIectomy and oophorectomy were carried out on one patient, and biIatera1 adrenaIectomy aIone on one patient. The patients ranged in age from thirty-seven to seventy-three years. Oophorectomy was carried out with the patients in the supine position and adrenaIectomy in the IateraI position. Since Iying on the side further impeded efficient ventilation, endotrachea1 anesthesia, with either assisted or controIIed respiration, was empIoyed in most instances. There is always the possibiIity of entering the pIeura1 space during adrenaIectomy, and use of a cuffed endotrachea1 tube makes possibIe immediate contro1 of respiration and appIication of positive pressure unti1 the rent in the pIeura can be surgicaIIy repaired. We have Iearned that psychologic preparation for a patient who is to undergo adrenaIectomy is of paramount importance. Most of our patients had undergone radica1 surgery previousIy, and many had been subjected to radiotherapy and additiona biopsies. Any patient facing surgery can make good use of her doctor’s understanding, but to a woman with carcinomatosis, on the verge of adrenaIectomy, sympathy and empathy can be of vita1 importance. Sudden and catastrophic changes can occur during adrenaIectomy. The probIems arising during surgery are hypertension, hypotension, tachychardia and coIIapse. Anesthetics which induce hypotension or make it diffIcuIt to maintain an even bIood pressure must be avoided. Deep anesthesia is Iikewise undesirabIe, because proIonged sIeeping time and deIay in reacting from anesthesia, resuIting from cere-" @default.
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• W2078359296 date "1957-10-01" @default.
• W2078359296 modified "2023-09-25" @default.
• W2078359296 title "The management of anesthesia for adrenalectomy" @default.
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• W2078359296 doi "https://doi.org/10.1016/0002-9610(57)90588-3" @default.
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