Anesthetic Support of Aldosteroma Surgery

Abstract

Anesthetic provision of retroperitoneoscopic adrenalectomy for hormone-active adrenal tumors still requires overcoming certain difficulties. This is due to significant metabolic and functional disorders that persist even after thorough preoperative preparation. In addition, the endovideoscopic intervention itself requires certain conditions, each of which is fraught with additional stress on the circulatory and respiratory systems.The objective: to develop a technique for anesthetic management of aldosteroma surgery.Subjects and Methods. The study involved 57 patients (42 women and 15 men aged from 38 to 62 years) who underwent retroperitoneoscopic adrenalectomy for aldosteroma. The patients were divided into two groups depending on the method of anesthesia. In Group 1 (n = 30), the operation was performed under combined anesthesia with low-flow desflurane inhalation as a basis and perioperative analgesia with systemic opioid administration. Patients of Group 2 (п = 27) were operated under anesthesia with low flow desflurane inhalation as a basis in combination with 0.35% ropivacaine solution blockade of the fascial space of the erector spinae plane muscle on the surgery side (ESP erector spinae plane). In order to optimize myoplegia, Group 2 was divided into three subgroups (A, Б, and В), 9 patients each. In patients of subgroup A, muscle relaxation was achieved by continuous administration of rocuronium bromide at the dose of 0.4 mg • kg-1 • h-1 throughout the operation. In subgroups Б and В, muscle relaxation was achieved by bolus administration of rocuronium bromide intravenously at the dose of 0.15 mg * kg-1 * h-1. Patients from subgroup A underwent no decurarization. In subgroup Б, for the purpose of decurarization, atropine sulfate 0.01 mg/kg and proserin 0.05 mg/kg were administered. In subgroup Б, sugammadex was administered at the dose of 4 mg/kg. Neuromuscular conduction was monitored, parameters of central and peripheral hemodynamics, anesthesia adequacy, quality of postoperative analgesia, and frequency of postoperative complications were assessed.Results. Combined anesthesia with desflurane with ESP blockade allows achieving the required level of its depth, providing adequate analgesia in the postoperative period, avoiding the use of high doses of opioid analgesics after surgery and thereby preventing the occurrence of complications associated with their use. The use of rocuronium bromide in patients with aldosteroma provides complete muscle relaxation at all stages of the video endoscopic intervention. The use of sugammadex makes the myoplegia technique manageable, which allows by the end of the operation to restore neuromuscular conduction, transfer to spontaneous breathing and activate the patient, which to a certain extent ensures the prevention of postoperative complications.Conclusions. The use of ESP block with combined anesthesia is an effective method of perioperative analgesia for retroperitoneoscopic adrenalectomy for aldosteroma, and also reduces the consumption of opioid analgesics and reduces the number of postoperative complications associated with their use. Continuous infusion of rocuronium bromide without deteriorating the quality of the neuromuscular block significantly reduces the consumption of the relaxant, and the use of sugammadex makes myoplegia controllable which is very important for patients with aldosteroma.

Keywords

• block of the fascial space of the erector spine muscle
• sugammadex
• guided muscle relaxation
• postoperative analgesia
• retroperitoneoscopic adrenalectomy