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 alpha-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 alpha(1)-blockade doxazosin before adrenalectomy. Group 2 received no alpha-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 alpha(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. J Hypertens 29: 2429-2432 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.