Patient selection: surgical resection of pheochromocytoma
Hemodynamic instability involved one or more of the following:
(1) systolic blood pressure > 200 mm Hg (hypertensive)
(2) systolic blood pressure > 130% of baseline (hypertensive)
(3) systolic blood pressure < 70% of baseline (hypotensive)
(4) heart rate > 110 beats per minute (tachycardia)
A patient may experience hemodynamic instability while the tumor is manipulated even if normotensive prior to surgery.
Factors associated with increased hemodynamic instability:
(1) large tumors
(2) open adrenalectomy (versus laparoscopic)
(3) use of selective alpha blockade (with doxazosin, prazosin or terazosin) rather non-selective alpha blockade (with phenoxybenzamine)
where:
• Open surgery tended to be done for larger tumors, bilateral tumors, resection of adjacent organs, tumor invasion of inferior vena cava, reoperation, or an attempt to spare the adrenal cortex.
• The postoperative outcomes were similar for the two blockade types.
