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• W2334106318 abstract "Editor—We would like to thank Drs Kakazu and Lippmann for the compliments on our letter1Foo CW Chen XY Kumar CM Anaesthetic management for laparoscopic bilateral adrenalectomy in MEN2A (Multiple endocrine neoplasia) followed by subsequent total thyroidectomy and radical neck dissection.Br J Anaesth. 2015; 114: 700-710Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar and sharing their experiences in the anaesthetic management of adrenalectomy. It is well established that proper perioperative optimization of the patient before surgery is one of the essential aspects in reducing intraoperative haemodynamic surges. The choice of preoperative drugs is influenced by local or international practice patterns and the availability of drugs.2Woodrum DT Kheterpal S Anesthetic management of pheochromocytoma.World J Endocr Surg. 2010; 2: 111-117Crossref Google Scholar Unfortunately, our patient could not be optimized fully despite using a combination of drugs; hence, a multidisciplinary team decision was made to proceed with surgery considering malignancy status. A myriad of approaches has been used, and almost all drugs in the lexicon of anaesthesia have been used in various combinations as part of a balanced anaesthesia technique.3Kinney MA Narr BJ Warner M Perioperative management of pheochromocytoma.J Cardiothorac Vasc Anesth. 2002; 16: 359-369Abstract Full Text Full Text PDF PubMed Scopus (210) Google Scholar The preferences and choice of maintenance of anaesthesia are subject to personal preference. There are advocates and opponents of both total i.v. anaesthesia and volatile agents.4Memtsoudis SG Swamidoss C Psoma M Anesthesia for adrenal surgery Chapter 28..in: Linos D van Heerden JA Adrenal Glands: Diagnostic Aspects and Surgical Therapy. Springer, New York2005: 287-297Crossref Scopus (8) Google Scholar 5Ebert TJ Muzi M Sympathetic hyperactivity during desflurane anesthesia in healthy volunteers. A comparison with isoflurane.Anesthesiology. 1993; 79: 444-453Crossref PubMed Scopus (261) Google Scholar There are advantages and disadvantages of both techniques. We prefer to use total i.v. anaesthesia with propofol and remifentanil for rapid and easy titratability, decreased risk of PONV, and smoother emergence. Tumour manipulation led to pronounced changes in blood pressure (SBP 200 mm Hg) requiring much higher doses of total i.v. anaesthesia drugs and sodium nitroprusside, but the control of blood pressure remained inadequate. Phentolamine i.v. resulted in an immediate desired response, but persistent tachycardia needed treatment. Labetalol i.v. (slow onset of action, relatively short duration of action, selective α- and non-selective β-adrenergic receptor antagonism) may not be the ideal drug. It was not first choice, and perhaps a selective β-adrenergic blocker might have been a better alternative. We agree with the authors’ insights on CO2 peritoneum, which has potential to cause haemodynamic instability.6Joris JL Hamoir EE Harstein GR et al.Hemodynamic changes and catecholamine release during laparoscopic adrenalectomy for pheochromocytoma.Anesth Analg. 1999; 88: 16-21PubMed Google Scholar However, surgery via a laparoscopic approach is increasingly performed despite its known concerns and is chosen by surgeons because it achieves outcomes similar to open surgery, has low pain scores, minimizes blood loss, has a shortened length of stay, and has low morbidity.7Kalady MF McKinlay R Olson Jr, JA et al.Laparoscopic adrenalectomy for pheochromocytoma. A comparison to aldosteronoma and incidentaloma.Surg Endosc. 2004; 18: 621-625Crossref PubMed Scopus (77) Google Scholar None declared." @default.
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• W2334106318 title "Reply from the authors Schneider regimen vs a volatile inhalation anaesthetic (desflurane) for laparoscopic adrenalectomy and additional considerations for delivery of anaesthesia" @default.
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