Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
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Volume 7, Number 1, January 2015, pages 1-7

Anesthetic Considerations on Adrenal Gland Surgery


Table 1. Conn’s Syndrome and Anesthetic Management
Conn’s syndrome Treatment
Preoperative period
  Preoperative hypokalemia Begin spironolactone, supplement kalium
  Hypertension Continue preoperative antihypertensive drugs
  Premedication Adequate sedation
Intraoperative period
  Metabolic alkalosis Avoid hyperventilation
  Hemodynamic state Strict hemodynamic control
  Potassium level, gas analysis Frequent measures of acid-base status and potassium blood level


Table 2. Clinical Manifestation of Cushing’s Syndrome [14]
Central obesity Thin extremities
Supraclavicular fat Proximal muscle weakness
Moon face Hypertension
Buffalo hump Hyperglycemia
Abdominal striae Metabolic alkalosis
Skin thinning Hypokalemia
Easy bruising Menstrual irregularities
Osteopenia Poor wound healing


Table 3. Perioperative Problems of Cushing’s syndrome Anesthetic Management
Cushing’s syndrome Treatment
Preoperative period
  Cortisol inhibition Adrenal enzyme inhibitors
  Hypertension Continue chronic therapy except ACEI and ARB
  Hyperglycemia Stop oral therapy and begin insulin regimen
  Hypokalemia Begin spironolactone and supplement potassium
  Perioperative hypercoagulative state LMWH, lower-extremity compression devices, and early postoperative mobilization
Intraoperative period
  Detailed anesthetic plan General endotracheal anesthesia ± epidural
  Positioning and taping Careful and gentle positioning, avoid fractures
  Premedication technique Avoid deep sedation
  Gastric aspiration risk Drugs, rapid induction, Sellick maneuver
  Airway management Careful preoxygenation, ensure correct intubation
  Venous access Large bore peripherial and central venous catheters
  Invasive monitoring Radial artery cannulation, Swan-Ganz if required
  Biochemistry tests Close monitoring of glycemia, electrolytes, and pH
  Postextubation respiratory failure Awake extubation, close monitoring
Postoperative period
  Acute pain therapy Aggressive treatment, systemic/epidural opioid
  Biochemistry tests Close monitoring of glycemia, electrolytes, cortisol and pH
  Postoperative respiratory failure Respiratory exercises, pain killers, mobilization
  Venous thrombotic episodes LMWH, early mobilization


Table 4. Sensitivity and Specificity of Pheochromocytoma Diagnosing Tests [10, 41]
Test/symptom Sensitivity (%) Specificity (%)
Vanillylmandelic acid 81 97
Catecholamine excretion 82 95
Metanephrine excretion 83 95
Abdominal CT scan 92 80
Paroxysmal hypertension, headache, sweating, tachycardia 90 95


Table 5. The Differences Between Phenoxybenzamine and Doxazosin
Phenoxybenzamine Doxazosin
Non selective α1-adrenergic blocker Selective α1-adrenergic blocker
Central signs present No central signs (headache, nasal stuffiness)
β-blocker always necessary β-blocker not always necessary
Prolonged and severe hypotension after adrenalectomy No significant hypotension after adrenalectomy
Postural hypotension No postural hypotension
Residual adrenergic blockade No residual adrenergic blockade


Table 6. Vasoactive Drugs Used During Pheochromocytoma’s Resection
Drug’s name Dose Comments
Vasodilator drugs (hypotensives)
  Propofol 2 - 2.5 mg/kg load, 25 - 75 μg/kg/min maintain Local irritation, propofol infusion syndrome
  Remifentanil 1 μg/kg load, 0.05 μg/kg/min maintain Respiratory depression, hyperalgesia, vomiting
  Dexmetedomidine 1 mg/kg load, 0.7 mg/kg/h maintain Sedative effects
  Nitroprusside 1 - 2 μg/kg/min Severe hypotension, cyanide toxicity
  Nitroglycerine 25 - 250 μg/min Reflex tachycardia, methemoglobinemia
  Nicardipine 5 mg/h Braycardia, severe hypotension, cardiac blocks
  Esmolol 5 - 10 mg/3 - 5 min bolus AV block, bronchial hyperactivity
  Labetalol 5 - 10 mg bolus
  Urapidil 10 - 15 mg/h Severe hypotension
  Clonidine 0.1 - 1.2 mg Rebound hypertension, dry mouth
  Magnesium sulfate 1 - 8 mg load, 1 - 4 mg/h maintain Potentiates muscle relaxants
Vasoconstrictor drugs (hypertensives)
  Epinephrine 1 - 20 μg/min Tachycardia
  Norepinephrine 1 - 30 μg/min Reflective bradycardia
  Dopamine 5 - 10 μg/min Tachycardia, arrhythmias
  Phenilephrine 10 - 100 μg/min Reflective bradycardia
  Vasopressin 0.1 - 0.4 units/min Myocardial infarction
  Ephedrine 5 - 10 mg None