Efficacy of alpha-Blockers on Hemodynamic Control during Pheochromocytoma Resection
| Autor: | Eleonora P M Corssmit, Robin P. F. Dullaart, Thera P. Links, Henri J L M Timmers, Gotz Wietasch, Ronald Groote Veldman, Peter H. Bisschop, Elisabeth M.W. Eekhoff, Edward Buitenwerf, Harm R. Haak, Magiel F Voogd, Thamara E. Osinga, Michiel N. Kerstens, Gerlof D. Valk, Jacques W.M. Lenders, Richard A Feelders |
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| Přispěvatelé: | Interne Geneeskunde, RS: CAPHRI - R1 - Ageing and Long-Term Care, Lifestyle Medicine (LM), Guided Treatment in Optimal Selected Cancer Patients (GUTS), Damage and Repair in Cancer Development and Cancer Treatment (DARE), Endocrinology, AGEM - Endocrinology, metabolism and nutrition, AMS - Ageing & Morbidty, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, AMS - Amsterdam Movement Sciences, AMS - Ageing & Vitality, Internal medicine, ACS - Diabetes & metabolism, Amsterdam Movement Sciences - Rehabilitation & Development, AMS - Tissue Function & Regeneration, Internal Medicine |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
PERIOPERATIVE MANAGEMENT sympathetic paraganglioma Phenoxybenzamine SURGERY BLOCKADE Endocrinology Diabetes and Metabolism PREOPERATIVE MANAGEMENT Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] Clinical Biochemistry Adrenal Gland Neoplasms Hemodynamics Blood Pressure BLOOD-PRESSURE Biochemistry law.invention 0302 clinical medicine Endocrinology Randomized controlled trial Interquartile range law adrenergic receptor blocker 030212 general & internal medicine Clinical Research Article Vascular damage Radboud Institute for Molecular Life Sciences [Radboudumc 16] ASSOCIATION Middle Aged hemodynamic instability pheochromocytoma Treatment Outcome PARAGANGLIOMA Anesthesia Female AcademicSubjects/MED00250 medicine.drug medicine.medical_specialty Mean arterial pressure 030209 endocrinology & metabolism Context (language use) 03 medical and health sciences Α-adrenergic receptor blocker Internal medicine medicine Doxazosin Humans Adrenergic alpha-Antagonists alpha-adrenergic receptor blocker MEAN ARTERIAL-PRESSURE INTRAOPERATIVE HYPOTENSION business.industry Biochemistry (medical) Blood pressure CLINICAL-PRACTICE business |
| Zdroj: | Journal of Clinical Endocrinology & Metabolism, 105(7), 2381-2391. Oxford University Press Journal of Clinical Endocrinology and Metabolism, 105(7), 2381-2391. ENDOCRINE SOC Journal of clinical endocrinology and metabolism, 105(7), 2381-2391. The Endocrine Society Journal of Clinical Endocrinology and Metabolism, 105, 7, pp. 2381-91 The Journal of clinical endocrinology and metabolism, 105(7), 2381-2391. The Endocrine Society The Journal of clinical endocrinology and metabolism, 105(7). Endocrine Society Journal of Clinical Endocrinology and Metabolism, 105 Buitenwerf, E, Osinga, T E, Timmers, H J L M, Lenders, J W M, Feelders, R A, Eekhoff, E M W, Haak, H R, Corssmit, E P M, Bisschop, P H L T, Valk, G D, GrooteVeldman, R, Dullaart, R P F, Links, T P, Voogd, M F, Wietasch, G J K G, Kerstens, M N & PRESCRIPT-investigators 2020, ' Efficacy of α-blockers on hemodynamic control during pheochromocytoma resection-a randomized controlled trial ', The Journal of clinical endocrinology and metabolism, vol. 105, no. 7, pp. 2381-2391 . https://doi.org/10.1210/clinem/dgz188 The Journal of Clinical Endocrinology and Metabolism Journal of Clinical Endocrinology and Metabolism, 105, 2381-91 Journal of Clinical Endocrinology and Metabolism, 105, 7 |
| ISSN: | 0021-972X |
| DOI: | 10.1210/clinem/dgz188 |
| Popis: | Context Pretreatment with α-adrenergic receptor blockers is recommended to prevent hemodynamic instability during resection of a pheochromocytoma or sympathetic paraganglioma (PPGL). Objective To determine which type of α-adrenergic receptor blocker provides the best efficacy. Design Randomized controlled open-label trial (PRESCRIPT; ClinicalTrials.gov NCT01379898) Setting Multicenter study including 9 centers in The Netherlands. Patients 134 patients with nonmetastatic PPGL. Intervention Phenoxybenzamine or doxazosin starting 2 to 3 weeks before surgery using a blood pressure targeted titration schedule. Intraoperative hemodynamic management was standardized. Main Outcome Measures Primary efficacy endpoint was the cumulative intraoperative time outside the blood pressure target range (ie, SBP >160 mmHg or MAP Results Median cumulative time outside blood pressure targets was 11.1% (interquartile range [IQR]: 4.3–20.6] in the phenoxybenzamine group compared to 12.2% (5.3–20.2)] in the doxazosin group (P = .75, r = 0.03). The hemodynamic instability score was 38.0 (28.8–58.0) and 50.0 (35.3–63.8) in the phenoxybenzamine and doxazosin group, respectively (P = .02, r = 0.20). The 30-day cardiovascular complication rate was 8.8% and 6.9% in the phenoxybenzamine and doxazosin group, respectively (P = .68). There was no mortality after 30 days. Conclusions The duration of blood pressure outside the target range during resection of a PPGL was not different after preoperative treatment with either phenoxybenzamine or doxazosin. Phenoxybenzamine was more effective in preventing intraoperative hemodynamic instability, but it could not be established whether this was associated with a better clinical outcome. |
| Databáze: | OpenAIRE |
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