title: Perioperative α-receptor blockade in phaeochromocytoma surgery: an observational case series.
abstract: BACKGROUND
  Mortality associated with surgery for phaeochromocytoma has dramatically decreased over the last decades. Many factors contributed to the dramatic decline of the mortality rate, and the influence of an α-receptor blockade is unclear and has never been tested in a randomized trial. We evaluated intraoperative haemodynamic conditions and the incidence of complications in patients with and without α-receptor blockade undergoing surgery for catecholamine producing tumours.
  
  
  METHODS
  Haemodynamic conditions and perioperative complications were assessed in 110 patients with (B) and 166 without (N) α-receptor blockade. Data were analysed as a consecutive case series of 303 cases and subsequently via propensity score matching, and presented as mean and confidence interval (CI).
  
  
  RESULTS
  No difference in maximal intraoperative systolic arterial pressures (B = 178 mm Hg (CI 169-187) vs N = 185 mm Hg (CI 177-193; P = 0.2542) and hypertensive episodes above 250 mm Hg were found (P = 0.7474) for the closed case series. No major complications occurred. Propensity score matching (75 pairs) revealed a significant difference of 17 mm Hg in maximal intraoperative systolic bp for these selected pairs (P = 0.024).
  
  
  CONCLUSIONS
  Only a slight difference in mean maximal systolic arterial pressure was detected between patients with or without an α-receptor blockade. There was no difference in the incidence of excessive hypertensive episodes between groups and no major complications occurred. The basis for the general recommendation of perioperative α- receptor blockade for phaeochromocytoma surgery demands further study.
authors.affiliation: Department of Anaesthesiology, Critical Care Medicine and Pain Therapy h.groeben@kliniken-essen-mitte.de.
authors.forename: H
authors.initials: H
authors.lastname: Groeben
authors.affiliation: Department of Anaesthesiology, Critical Care Medicine and Pain Therapy.
authors.forename: B J
authors.initials: BJ
authors.lastname: Nottebaum
authors.affiliation: Department of Surgery and Center of Minimal Invasive Surgery.
authors.forename: P F
authors.initials: PF
authors.lastname: Alesina
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Traut
authors.affiliation: Department of Nephrology and General Medicine, University Medical Center, Albert-Ludwigs-University, Freiburg, Germany.
authors.forename: H P
authors.initials: HP
authors.lastname: Neumann
authors.affiliation: Department of Surgery and Center of Minimal Invasive Surgery.
authors.forename: M K
authors.initials: MK
authors.lastname: Walz
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000503:physiopathology / Q000601:surgery*; D000317:Adrenergic alpha-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000503:physiopathology / Q000601:surgery*; D057216:Propensity Score; D055815:Young Adult
chemical_list: D000317:Adrenergic alpha-Antagonists
keywords: doxazosin; paraganglioma; phaeochromocytoma; phenoxybenzamine