Perioperative α-receptor blockade in phaeochromocytoma surgery: an observational case series †

<span class="paragraphSection"><strong>Background.</strong> 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.<strong>Methods.</strong> 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).<strong>Results.</strong> No difference in maximal intraoperative systolic arterial pressures (B = 178 mm Hg (CI 169-187) <span style="font-style:italic;">vs</span> N = 185 mm Hg (CI 177-193; <span style="font-style:italic;">P</span> = 0.2542) and hypertensive episodes above 250 mm Hg were found (<span style="font-style:italic;">P</span> = 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 (<span style="font-style:italic;">P</span> = 0.024).<strong>Conclusions.</strong> 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.</span>

http://ift.tt/2iPPMzH