Alagla, N. (2017) Effect of Selective Versus Non-selective α-Blockers on the Hemodynamic Stability in Patients with a Pheochromocytoma. thesis, Medicine.
Full text available on request.Abstract
Background: The use of preoperative α-blockers in patients scheduled for resection of a pheochromocytoma (PCC) is recommended in order to reduce hemodynamic instability and its associated cardiovascular complications during surgery. The choice between non-selective (PXB) and selective (DOX) α-blockers remains controversial. Aim: The aim of this study was to determine the optimal α-blocker for pretreatment of patients with PCC undergoing adrenalectomy. Methods: This interim analysis is part of a large multicenter, randomized prospective study. Patients >18 years with a benign PCC were included and assigned randomly to pretreatment with either DOX or PXB. Dosages of either α-blocker were titrated in order to achieve specific targets for blood pressure (BP) and heart rate (HR). Anesthetic procedures were standardised. Primary endpoint was the frequency of intraoperative BP episodes outside the target range (i.e. Systolic BP>160 mmHg, MAP<60 mmHg or HR>100/min). Secondary endpoint was the defined daily dosage (DDD) of antihypertensive agents, in addition to α-blockers, needed to achieve preoperative BP targets. Data are presented as mean + SD, median [IQR] or percentages. A two-sided P-value <0.05 was considered significant. Results: 108 patients were included, 54 in each treatment group. There were no differences in baseline characteristics between the groups. The duration of the preoperative treatment was not different between groups. Median dose was 120 [77.8-140] mg and 46 [27-48]mg in PXB and DOX, respectively. Preoperative BP measurements showed no differences between groups except for a significantly higher diastolic BP in the PXB group compared to the DOX group ( [77 [67-85] and 67 [62-79]mmHg, respectively, P<.01). β-blockers were initiated in the PXB and DOX groups in 89% and 63%, respectively (P<.01). DDD of antihypertensive medication, besides α- and β-blockers, was not different between the groups. Median number of intraoperative episodes outside target range for SBP and MAP was 0.5[0-2] and 2.5 [0-5] in the PXB group and 2 [0-4] and 3 [1-5] in the DOX group, respectively (NS). No difference was observed in postoperative outcome between groups. Conclusion: Pretreatment with either PXB or DOX demonstrated no difference in intraoperative hemodynamic control during resection of a pheochromocytoma. The need for additional antihypertensive agents other than α- and β-blockers, was not different between groups. PXB-treated patients, however, required more often administration of β-blockers for control of preoperative tachycardia.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Kerstens, M.N. MD and Other supervisors: and Buitenwerf, E. MD Department of Endocrinology |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:07 |
| Last Modified: | 25 Jun 2020 11:07 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2655 |
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