dc.contributor.author | Maina, Jane W | |
dc.date.accessioned | 2013-05-23T13:43:14Z | |
dc.date.available | 2013-05-23T13:43:14Z | |
dc.date.issued | 1991 | |
dc.identifier.citation | Degree Of Master of Medicine in Anaesthesia | en |
dc.identifier.uri | http://erepository.uonbi.ac.ke:8080/xmlui/handle/11295/24970 | |
dc.description | A dissertation submitted in part fulfilment
for the requirements of the Degree
Of Master of Medicine in Anaesthesia of
the University Of Nairobi,1991 | en |
dc.description.abstract | The anaesthetic management of 14 patients undergoing
surgical removal of phaeoch romocytoma is described.
Hypertension was present in a 11 the pat ients. A 24
hours urine specimen for the determination of
vani11ymande1ic acid (VMA) for the presence of
phaeochromocytoma was the diagnostic method used in
all the patient. The VMA levels were elevated in 10
patients (71.4%). In 57. 1% of the patients , the
tumours were located in the adrenal gland.
The control of cardiovascular d istu rbahces due to
phaeoch romocytoma prior to su rge ry was achieved by
alpha and beta adrenergic blocking drugs,
phenoxybenzamine and propranolol or oxprenolol
respectively. Significant control of blood pressure
was observed in 12 patients who where pretreated with
both alpha and beta adrenergic blocking agents. The
" effect of the pretreatment was analyzed using the
paired 't' test. General anaesthesia was administered
to all patients undergoing surgical removal of the
tumour. Induction of anaesthesia was done with
thiopentone, morphine or fentanyl, diazepam and
droperido1.
combinations.
These drugs were used in various
Muscle relaxants,
tubocu rari ne, pipercuronium,
pancuronium,
vercuroni um
dor
suxamethonium were used to facilitate smooth
endotracheal intubation. Maintenance of anaesthesia
was achieved with halothane in 7 patients, ethrane in
3 patients, neuroleptanalgesia in 4 patients and
narcotic analgesics in 2 patients.
A marked rise in blood pressure was observed during
endotracheal intubation, skin incision and tumour
manipulation.
were used to
.Phentolamine or sodium nitroprusside
control the marked rise in blood
pressure. The incidence of arrthymias was very low
(14.3%) and they were effectively controlled with
Lignocaine or propranolol. Fall in blood pressure was
noted after complete excision of the tumour. Severe
fall in blood pressure occurred in 5 patients. This
was corrected by infusing large volumes of intravenous
fluids such as normal saline, hartman's solution, 5%
dextrose, dextran and blood. Sympathomi met ic agents
metaraminol and dopamine were administered to 2
patients in addition to intravenous fluids to correct
the hypotension. The cure rate after tumour resection
was 64.3%. | en |
dc.language.iso | en | en |
dc.publisher | University of Nairobi | en |
dc.title | A descriptive study on the anaesthetic management of patients undergoing surgical removal of phaeochromocytoma. a retrospective review | en |
dc.type | Thesis | en |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |
local.publisher | College of Health Sciences | en |