TY - JOUR
TI - To block, or not to block … is it still the question? {Effectiveness} of alpha- and beta-blockade in phaeochromocytoma surgery: an institutional analysis.
AU - Van Den Heede, K.
AU - Paspala, A.
AU - Chander, N.
AU - Chidambaram, S.
AU - Wernig, F.
AU - Todd, J. F.
AU - DiMarco, A. N.
AU - Palazzo, F. F.
JO - Annals of the Royal College of Surgeons of England
PY - 2021
VL - null
TODO - null
SP - null
PB - 
SN - 0035-8843, 1478-7083
TODO - 10.1308/rcsann.2021.0133
TODO - Adrenalectomy, Alpha-blockers, Haemodynamic instability, Phaeochromocytoma, Phenoxybenzamine
TODO - INTRODUCTION: Phaeochromocytomas/paraganglioma (PPGL) surgery was historically associated with significant risks of perioperative complications. The decreased  mortality (<3.0%) had been attributed in part to optimal preoperative  alpha-blockade. The value of alpha-blockade in decreasing morbidity is being  challenged. The aim of our study is to present an institutional experience of  preoperative alpha-blocking of PPGL and its effect on cardiovascular stability and  postoperative morbidity. METHODS: A retrospective study using data from our  institutional database was conducted. All patients undergoing adrenalectomy for PPGL  from October 2011 to September 2020 were included. All patients were routinely  alpha-blocked. Intraoperative cardiovascular instability (ICI) was assessed through  number of systolic blood pressure (SBP) episodes >160mmHg, SBP <90mmHg, the need for  vasoactive drugs and volume of intraoperative crystalloids administered. Morbidity  was also evaluated. RESULTS: A total of 100 consecutive patients undergoing surgery  were identified of whom 53 patients had complete anaesthetic records available for  analysis. Thirty-two patients (60%) had at least one episode with an SBP >160mmHg.  Nine (17%) cases had no intraoperative hypotensive episodes, while 3 (6%) patients  had >10 intraoperative episodes of an SBP <90mmHg. Twenty-one (40%) patients  received vasoactive drugs during surgery. The median volume of intraoperative  crystalloids was 2 litres (1-4). Postoperatively, no patient experienced  cardiovascular complications, including arrhythmia or myocardial ischaemia. Only two  were admitted to an intensive care unit (ICU) and one 30-day readmission occurred.  CONCLUSIONS: Cardiac instability remained significant in PPGL surgery despite  optimal alpha- and beta-blockade. While omitting blockade would appear empirically  questionable, a randomised controlled trial (RCT) of surgery with and without  alpha-blockade will provide an answer.
ER -