Anesthesia for adrenalectomy; clinical report on fifty-four procedures.

Abstract

The histories of 41 patients who had undergone adrenalectomy were reviewed with respect to the relative advantages of the various types of anesthesia used at operation. The positioning of the patient precluded the possibility of satisfactory spinal anesthesia. The most frequent procedure consisted of premedication with pentobarbital, meperidine, and atropine, induction with intravenously given thiopental sodium and tubocurarine, and endotracheal administration of nitrous oxide, oxygen, and ether. Although four hypotensive episodes occurred, there were no surgical or anesthetic deaths. This good result is ascribed to a careful program of steroid replacement therapy involving the preoperative use of cortisone acetate, the availability of hydrocortisone in both operating and recovery room for use if hypotension developed, and the use of cortisone in the recovery room and throughout the postoperative life of the patient.