Preoperative alpha blockade for normotensive pheochromocytoma:  is it necessary?
OBJECTIVE
To compare the intraoperative hemodynamics in normotensive pheochromocytoma patients undergoing tumor resection between those with α-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 α1-blockade doxazosin before adrenalectomy. Group 2 received no α-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.


CONCLUSIONS
Preoperative α1-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.
Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Yuan
Y
Shao
Ran
R
Chen
Zhou-jun
ZJ
Shen
Ying
Y
Teng
Peng
P
Huang
Wen-bin
WB
Rui
Xin
X
Xie
Wen-long
WL
Zhou
D000310:Adrenal Gland Neoplasms / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D000315:Adrenalectomy; D000317:Adrenergic alpha-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D017292:Doxazosin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D010673:Pheochromocytoma / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications; D011300:Preoperative Care
D000317:Adrenergic alpha-Antagonists; D017292:Doxazosin