Does Alpha Adrenergic Blocking Agent Choice Effect Preoperative Preparation in Pheochromocytoma?

Pheochromocytoma is a catecholamine-producing tumor of cells of neural-crest origin. It commonly develops in the adrenal medulla but may arise within sympathetic ganglia outside the adrenal glands in about 10 % of patients. The most common clinical features
of a pheochromocytoma are hypertension, headaches, palpitations, and sweats. The importance of this disease in the perioperative period is that, patients with these tumors are at high risk for hypertensive crisis or catecholamine-induced arrhythmias during anesthesia, surgery, or arteriography. 25 to 50 per cent of hospital deaths of patients with pheochromocytoma occur during induction of anesthesia or during operative procedures. Once the diagnosis is made, the tumor must be localized and prepared for surgery. Preoperative use of alpha adrenergic blocking drugs is recommended because they are likely to re-duce the incidence of hypertensive crisis. The standart preparation generally used is phenoxybenzamine but, prazosin and doxazosin are also being used by some clinicians. 37 years-old female patient was scheduled to undergo surgery for
removal of an adrenal mass which infact was an unrecognized pheochromocytoma. Following standart monitorizing and anesthesia induction operative procedure began. The blood pressure increased to 270/150 mmHg and pulse was 120/min immediately
after surgical manipulations. The operation was terminated and planned to postpone for diagnose and preope-rative preparation with an alpha blocking agent. Doxazosin was started by an internist and the patient was monitorized for blood pressure, ECG, for three
weeks. The second surgical attempt was also unsuccessful because of a hypertensive crisis during induction of anesthesia just before laryngoscopy and endotracheal intubation. We conclude that, alpha-adrenergic blockade with doxazosin was not sufficient for preoperative preparation of pheochromocytoma leading to uncontrolled hypertensive reaction immediately after induction in our patient.

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