title: Both preoperative alpha and calcium channel blockade impact intraoperative hemodynamic stability similarly in the management of pheochromocytoma.
abstract: BACKGROUND
  Alpha-blockade is the standard management preoperatively to prevent intraoperative hemodynamic instability (IHD) during resection of a pheochromocytoma. Calcium channel blockers also have been shown to lessen the risk of IHD. We aim to determine differences between these classes of antihypertensive agents in minimizing IHD.
  
  
  METHODS
  This was a retrospective analysis from a tri-institutional database. Inclusion criteria were unilateral transabdominal adrenalectomy for pheochromocytomas between 2002 and 2012. IHD was defined as at least one systolic blood pressure (SBP) measurement >160 mm Hg and at least one episode of mean arterial pressure 60 mm Hg.
  
  
  RESULTS
  A total of 155 patients were included: 110 receiving calcium channel blockers, 41 alpha-blockade, and 4 no medication. Intraoperatively, mean maximal SBP was less after alpha-blockade (P < .0001) as well as the incidence and duration of episodes of SBP >200 mm Hg (P < .01); however, severe hypotensive episodes (MAP <60 mm Hg) were more frequent (P < .001) and longer (P < .0001) with alpha-blockade. Consequently, intraoperative vasoactive drugs were used more frequently (P = .03), and mean fluid volume infused was larger (P < .001). Fifty-four patients had IHD, but these were independent of type of preoperative medication used. Familial disease was the only independent predictor of IHD.
  
  
  CONCLUSIONS
  IHD was independent of type of preoperative medical management but was dependent on familial disease. These findings broaden options for clinicians in the preoperative management of pheochromocytoma.
authors.affiliation: Department of Digestive, Hepato-Biliary and Endocrine Surgery, CHU Nancy - Hospital Brabois Adultes, University de Lorraine, Nancy, France; Faculty de medicine, INSERM U954, University de Lorraine, Nancy, France. Electronic address: l.brunaud@chu-nancy.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Brunaud
authors.affiliation: Department of Digestive and Endocrine Surgery, CCDE, IMAD, CHU Nantes, Université de Nantes, Nantes, France.
authors.forename: Myriam
authors.initials: M
authors.lastname: Boutami
authors.affiliation: Department of Clinical Epidemiology and Evaluation, CHU Nancy, University de Lorraine, Nancy, France.
authors.forename: Phi-Linh
authors.initials: PL
authors.lastname: Nguyen-Thi
authors.affiliation: Division of Endocrine and Minimally Invasive Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: Brendan
authors.initials: B
authors.lastname: Finnerty
authors.affiliation: Department of Digestive, Hepato-Biliary and Endocrine Surgery, CHU Nancy - Hospital Brabois Adultes, University de Lorraine, Nancy, France; Faculty de medicine, INSERM U954, University de Lorraine, Nancy, France.
authors.forename: Adeline
authors.initials: A
authors.lastname: Germain
authors.affiliation: Department of Endocrinology, University de Lorraine, CHU Nancy - Hospital Brabois Adultes, Nancy, France.
authors.forename: Georges
authors.initials: G
authors.lastname: Weryha
authors.affiliation: Division of Endocrine and Minimally Invasive Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Fahey
authors.affiliation: Department of Digestive and Endocrine Surgery, CCDE, IMAD, CHU Nantes, Université de Nantes, Nantes, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Mirallie
authors.affiliation: Department of Digestive, Hepato-Biliary and Endocrine Surgery, CHU Nancy - Hospital Brabois Adultes, University de Lorraine, Nancy, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Bresler
authors.affiliation: Division of Endocrine and Minimally Invasive Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: Rasa
authors.initials: R
authors.lastname: Zarnegar
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods*; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D010673:Pheochromocytoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D011300:Preoperative Care; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D000317:Adrenergic alpha-Antagonists; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers