Doxazosin versus phenoxybenzamine as pretreatment for pheochromocytoma surgery.

Bolt, J. (Janneke) (2015) Doxazosin versus phenoxybenzamine as pretreatment for pheochromocytoma surgery. thesis, Medicine.

Text BoltJ.pdf Restricted to Registered users only Download (558kB)

Abstract

Introduction Alpha-blockers are used preoperatively before pheochromocytoma surgery to prevent cardiovascular complications. Whether phenoxybenzamine (PXB) (non-selective and non-competitive α-blockers) or doxazosin (DOX) (selective and competitive α-blockers) should be preferred, is unclear. We assessed the differences in intraoperative hemodynamic instability in patients pretreated with DOX or PXB. Methods Medical records of patients who underwent a pheochromocytoma resection at our hospital between 1995-2012 were reviewed. Primary endpoint was the duration of hypertension (systolic blood pressure (SBP) ≥ 160 mmHg) and/or tachycardia (heart rate (HR) ≥100 bpm). Secondary endpoint was postoperative outcome. Data are presented as mean ±SD or median [interquartile range (IQR)]. Differences between groups were evaluated univariate and multivariate, using variables correlating with intraoperative hypertension and/or tachycardia. Results Data of 68 patients were analyzed (DOX n=40, PXB n=28). Patients in the DOX-group were older (53±17 vs 44±16 years), had a lower ASA-classification, lower 24-h-urinary metanephrines (811 [113-1542] vs 1930 [888-4676] μmol/mmol creat), lower mean arterial pressure (MAP) (104±18 vs 115±24 mmHg) and lower HR preoperatively (76±10 vs 90±23 bpm) compared to patients in the PXB-group (all P<.05). The duration of hypertension was not different between DOX- and PXB-group; 20 [1-34] vs 25 [5-54] minutes respectively (P = .28). Duration of tachycardia was longer in the DOX- group, 0 [0-5] minutes compared to the PXB-group; 23 [0-60] minutes (P < .001). Multivariate analysis disclosed an independent positive relationship of the intraoperative hypertension with the metanephrine concentration. In addition, there was an independent positive relationship of the intraoperative tachycardia with PXB use. Postoperative hospital stay in the DOX and PXB-group was 5 [6-8] and 7 [4-13] days, respectively (P = .01). Fewer patients (33%) in the DOX-group were admitted to the ICU compared to the PXB-group (68%) (P < .01). Conclusion No differences were found in intraoperative hypertension between pretreatment with either DOX or PXB. However, we found a positive predicting value of PXB for intraoperative tachycardia.

Item Type:	Thesis (Thesis)
Supervisor name:	Kerstens, M.N. MD PhD and Horst-Schrivers, A.N.A. van der MD PhD
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:59
Last Modified:	25 Jun 2020 10:59
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1993

Actions (login required)

View Item