Preoperative and Operative Management of Patients with Phaeochromocytoma

Abstract

The high mortality of surgical removal of a phaeochromocytoma prompted the use of adrenergic blocking agents in preoperative and operative management. This paper details experience with the use of various α- and β-adrenergic blocking agents in 27 patients. The short duration of action of phentolamine and the tachycardia it produces limits its usefulness as an α-blocker, and preference is given to phenoxybenzamine. This drug is given intravenously for three days before operation to control blood pressure and enable the blood volume to re-expand. Removal of the tumour is not promptly followed by hypotension provided α-blockade is adequate and blood loss is replaced. The use of noradrenaline is thereby avoided. Tachycardia and arrhythmias are controlled by β-blockers given orally preoperatively, and intravenously with caution during operation. Initially pronethalol was used, but this has been superseded by propranolol. Complete α- and β-blockade is not advocated, and β-blockade must not be used without previous administration of an β-blocking agent. Dangers of anaesthesia are outlined, especially the hypotensive effect of thiopentone in the presence of adrenergic blockade and the occurrence of arrhythmias with hydrocarbon anaesthetic agents. The response to haemorrhage is modified by these drugs; frequent arterial and venous pressure measurements and E.C.G. monitoring are essential for adequate blood replacement and prevention of overtransfusion. A suggested procedure for the management of these patients is outlined. Removal of a phaeochromocytoma still remains a potentially hazardous procedure, and its success depends largely upon the harmonious co-operation of a team comprising physician, pharmacologist, anaesthetist, and surgeon. © 1967, British Medical Journal Publishing Group. All rights reserved.