Perioperative management of 63 patients with pheochromocytoma
Azmy R. Boutros, MB, FFARCS, FRCPAddress reprint requests to A.R.B., Division of Anesthesiology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195.
Emmanuel L. Bravo, MD
Giorgio Zanettin, MD
Ralph A. Straffon, MD
During a 10-year period, 60 patients with confirmed diagnoses of pheochromocytoma underwent a total of 63 surgical procedures. To control extreme blood pressure elevations, 6 patients received phenoxybenzamine preoperatively and 28 patients received prazosin. The remaining 29 patients received neither drug. Intravenous sodium nitroprusside and nitroglycerin, alone or in combination, were used in all but 10 patients to control intraoperative hypertensive episodes. One patient died after surgery due to pre-existing intracranial malignant tumor. All other patients were discharged from the hospital with no clinical evidence of stroke or myocardial infarction. We conclude that pheochromocytoma patients can undergo successful surgery without preoperative profound and long-lasting alpha adrenergic blockade.