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Background: Severe hemodynamic instability may occur during surgery for removal of pheochromocytoma, unless there is preoperative pharmacological treatment. Objective: To evaluate the effects of metyrosine (α-methyl-p-tyrosine), a catecholamine synthesis inhibitor, and α-blockade with prazosin or phenoxybenzamine on cardiovascular morbidity during surgery for pheochromocytoma. Methods: A retrospective analysis was made of patients followed up at the Medical College of Georgia, Augusta, during 28 years who received metyrosine and prazosin (n=6), metyrosine and phenoxybenzamine alone (n=14),phenoxybenzamine alone (n=6), or no medication (n=7) during 3 weeks before tumor removal. The percentage of patients not requiring pressors or phentolamine during the intraoperative period as well as the perioperative peak systolic pressures and peak heart rates were estimated in each group. Results: There was a significant (P Conclusions: The combination of α-metyrosine and α-blockade results in better blood pressure control and less need for use of antihypertensive medication or pressors during surgery, compared with the classical method of single-agent adrenergic blockade. Preoperative treatment with metyrosine along with an α-blocker is a useful strategy for decreasing the surgical morbidity in patients with pheochromocytoma and assumes greater importance as long as the availability of phentolamine for intraoperative use is a problem. Arch Intern Med. 1997;157:901-906 |
