CaseReportA33-year-oldwomanweighing108kgwithobesityandneurofibromatosiswaspresentedwitha2-yearhistoryofpoorlycontrolledhypertension,headaches,palpitations,andoccasionalchestpain.Herbloodpressurewas170/100mmHg,andshewastreatedwithdailyoraldoseofdiltiazem(360mg),hydrodiuril(12.5mg),lisinopril(20mg),andmetoprololXL(25mg)tablets.患者,女33岁,体重108公斤.肥胖和神经纤维瘤病，难以控制高血压2年，伴头痛，心悸，偶尔胸痛。她的血压是170/100毫米汞，每日口服地尔硫卓（360毫克），二氢氯噻（12.5毫克），赖诺普利（20毫克），和美托洛尔加大码（25毫克）片控制血压。Biochemicalevaluationforpheochromocytomashowedelevated24-hoururinemetanephrinelevelsof5496mcgandnormetanephrinelevelof6415mcg.Acomputedtomographicscanoftheabdomenshoweda6_6-cmrightadrenalmass.Theremainderofherpreoperativetestswasotherwisenormal.生化提示嗜铬细胞瘤,24小时尿肾上腺素水平5496微克和去甲肾上腺素水平的6415微克。腹部CT扫描发现了6_6-cm右肾上腺肿块。其余的术前检查正常。Threeweeksbeforesurgery,thepatientwasstartedonphenoxybenzamineof10mgperdayorally,whichwasgraduallyincreasedto30mg3timesaday.在手术前三周，病人开始每天口服酚苄明从10mg逐渐增加到30mg，一天3次。Thedaybeforetheplannedsurgery,thepatientwasadmittedtosurgicalfloor,heraveragebloodpressureandheartratewere134/76mmHgand65bpm,respectively.Atmidnight,shewasgivenanextradoseof40mgofphenoxybenzamineandalsoreceived1Lof5%dextrosewith0.45%normalsaline.术前一天，病人被送往外科楼,她的平均血压134/76毫米汞，心率65次/分。在术前当晚，患者口服一个额外的40毫克酚苄明，并输注5%葡萄糖氯化钠注射液1000ml。Thefollowingmorningpatientwastakentotheoperatingroom,standardmonitorswereapplied,andaradialarterialandcentralvenouslinewasplaced.翌日早上病人被送到手术室，入室后接标准监护仪，并桡动脉和中心静脉置管。Anesthesiawasinducedwithintravenouspropofol(200mg),fentanyl(100mcg),rocuronium(60mg),andmaintainedwithend-tidalsevoflurane2.0%to3.0%in66%nitrousoxideand34%oxygen.Thepatientwasventilatedwith8to10ml/kgtidalvolumetomaintainanend-tidalCO2between33and36mmHg.Thepatientwaspositionedinaleftlateraldecubituspositionanda4-porttechniqueforlaparoscopywasused.麻醉静脉诱导：异丙酚（200毫克），芬太尼（100微克），罗库溴铵（60毫克），麻醉维持：七氟醚2%-3%，66%的一氧化二氮和34%的氧气。潮气量8至10毫升/公斤，保持呼气末二氧化碳之间33和36毫米汞。病人左侧卧位和4技术的腹腔镜手术。Afterinduction,intubation,andinsufflationoftheabdomen,thepatient’sbloodpressureandheartrate