Preoperative alpha blockade for normotensive pheochromocytoma: is it necessary?
J Hypertens. 2011 Dec;29(12):2429-32
Authors: Shao Y, Chen R, Shen ZJ, Teng Y, Huang P, Rui WB, Xie X, Zhou WL
OBJECTIVE: To compare the intraoperative hemodynamics in normotensive pheochromocytoma patients undergoing tumor resection between those with ?-blockade preparation, preoperatively, and those without it.
METHODS: From January 2003 to July 2011, patients with adrenal incidentaloma, which was highly suspected as normotensive pheochromocytoma, were divided into two groups. Group 1 recieved ?1-blockade doxazosin before adrenalectomy. Group 2 received no ?-adrenoceptor, preoperatively. Data regarding the intraoperative hemodynamics was collected. These include peak/nadir blood pressure (BP) and heart rate, vasoactive medication and fluid infusion.
RESULTS: Fifty-nine cases of pheochromocytoma were confirmed by histopathology examination: 38 in group 1 and 21 in group 2. No differences were found in the preoperative demographics, comorbidities, BP and anesthesia. Intraoperative BP and heart rate showed no difference between these two groups. Intraoperative use of nitroglycerin (P?<?0.001), norepinephrine (P?<?0.001), phentolamine (P?<?0.001) and colloid fluid (P?=?0.008) was significantly greater in group 1 with doxazosin.
CONCLUSION: Preoperative ?1-adrenoceptor antagonist has no benefit in maintaining intraoperative hemodynamic stability in patients with normotensive pheochromocytoma. It may increase the use of vasoactive drugs and colloid infusion.
PMID: 22025238 [PubMed - indexed for MEDLINE]