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Canadian Journal of Anesthesia, Vol 31, 681-686, Copyright © 1984 by Canadian Anesthesiologists' Society

Anaesthetic Management with Morphine in Phaeochromocytoma

MASAYASU HAMAJI MD1, NORIFUMI OKA MD1, CHIKARA TASHIRO MD1, TOKUICHIRO SEKI PHD1, MASAHIKO MIYATA MD1, and YASUNARU KAWASHIMA MD1

1 First Department of Surgery and the Department of Anesthesiology, Osaka University Medical School, and the Department of Biochemistry, College of Bio-medical Technology and Nursing, Osaka University

Address correspondence to: Dr. M. Hamaji, First Dept. of Surgery, Osaka University Medical School, Fukushima-Ku, Osaka 553 Japan.

Morphine was used as the principal anaesthetic agent for five patients undergoing resection of phaeochromocytoma, and changes in plasma catecholamines were monitored. Phenoxygenzamine (0.5 mg·kg-1·day-1) was orally given one week before operation. After premedication with hyoscine (0.4 mg) and diazepam (20 mg) of meperidine (50 mg), anaesthesia was induced with an infusion of morphine (1 mg·kg-1) over 30 min and maintained with diazepam, nitrous oxide and oxygen. Pancuronium was used as the muscle relaxant. In three of the five patients, blood pressure transiently rose (ranging from 15 to 60 mg) following orotracheal intubation, but vasodilators were not required. In two of the three, plasma norepinephrine increases were 1.1 and 1.3 ng·ml-1 In the other two patients, whose blood pressure was stable, the change in plasma norepinephrine was 0.1 and 0.7 ng·ml-1. After reaching a peak at the time of ligation of drainage vein from the tumour, plasma catecholmines rapidly decreased to the preoperative levels, but the blood pressure was well maintained in all cases. Ventricular arrhythmias did not occur despite the increased levels of endogenous catecholamines.

These findings suggest that morphine can be used as an alternative anaesthetic agent during operation for phaeochromocytoma and that exaggerated pressor responses to morphine (when given slowly) seem not to occur in phaeochromocytoma.

Key Words: ANALGESICS: morphine • SURGERY: phaechromocytoma






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Copyright © 1984 by the Canadian Anesthesiologists' Society.