Skip to main content
SpringerLink
Log in

Präoperative α-Rezeptoren-Blockade beim Phäochromozytom? – Kontra

Preoperative α-receptor block in patients with pheochromocytoma? Against

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

In den letzten 50 Jahren konnte die Mortalität im Rahmen der Resektion katecholaminproduzierender Tumoren erheblich gesenkt werden. Hierzu haben viele Faktoren wie die Entwicklungen der chirurgischen Technik, intraoperative Kreislaufüberwachung und Steuerung sowie eine verbesserte Diagnostik beigetragen. Häufig wird als maßgeblicher Faktor die perioperative Blockade der α-Rezeptoren benannt. Die Effektivität dieser Blockade wurde bisher in keiner Studie ausreichend überprüft. In vielen Studien wird trotz α-Rezeptor-Blockade von Blutdruckanstiegen weit über 200 mmHg berichtet.

Von 200 konsekutiven Resektionen haben wir 73 Patienten ohne α-Rezeptor-Blockade betreut und keinen signifikanten Unterschied in den maximalen intraoperativen Blutdruckwerten und der Blutdruckanstiege über 200 mmHg festgestellt. Außerdem ließ sich kein dosisabhängiger Effekt von Phenoxybenzamin auf den maximalen intraoperativen Blutdruck nachweisen.

Daher muss in Anbetracht der nicht unerheblichen Nebenwirkungen und des Zeitaufwands für die Titration einer α-Rezeptor-Blockade die Effektivität und der routinemäßige Einsatz dieser Blockade infrage gestellt werden.

Abstract

Perioperative mortality regarding the resection of catecholamine-producing tumors has been markedly improved. This improvement has been attributed to the preoperative treatment with α-receptor blocking agents. An α-receptor block is still recommended prior to the resection of pheochromocytoma or paraganglioma. However, the effect has never been tested in a randomized clinical trial. Despite an assumed effective α-receptor block, many centers report systolic blood pressure increases beyond 200 mmHg.

Out of 200 consecutive resections of catecholamine-producing tumors, 73 patients without an α-receptor blockade were treated. There was no significant difference in the maximum systolic blood pressure or in the incidence of hypertensive episodes. There was no correlation between the individual dose of phenoxybenzamine and the maximum blood pressure.

Overall it can be concluded that with the improvement of surgical techniques, diagnostic tools and highly effective short acting substances to control hemodynamics intraoperatively, the question must be raised whether a time-consuming, unreliable pretreatment burdened with significant side effects is still required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Welbourn RB (1987) Early surgical history of phaeochromocytoma. Br J Surg 74:594–596

    Article  PubMed  CAS  Google Scholar 

  2. Orchard T, Grant CS, Heerden JA van, Weaver A (1993) Pheochromocytoma – Continuing evolution of surgical therapy. Surgery 114:1153–1159

    PubMed  CAS  Google Scholar 

  3. Modlin IM, Farndon JR, Shepherd A et al (1979) Phaeochromocytomas in 72 patients: clinical and diagnostic features, treatment and long term results. Br J Surg 66:456–465

    Article  PubMed  CAS  Google Scholar 

  4. Plouin PF, Duclos JM, Soppelsa F et al (2001) Factors associated with perioperative morbidity and mortality in patients with pheochromocytoma: analysis of 165 operations at a single center. J Clin Endocrinol Metab 86:1480–1486

    Article  PubMed  CAS  Google Scholar 

  5. Desmonts JM, Marty J (1984) Anaesthetic management of patients with phaeochromocytoma. Br J Anaesth 56:781–789

    Article  PubMed  CAS  Google Scholar 

  6. Lebuffe G, Dosseh ED, Tek G et al (2005) The effect of calcium channel blockers on outcome following the surgical treatment of phaeochromocytomas and paragangliomas. Anaesthesia 60:439–444

    Article  PubMed  CAS  Google Scholar 

  7. Pacak K, Eisenhofer G, Ahlman H et al (2007) Pheochromocytoma: recommendations for clinical practice from the first international symposium. Nat Clin Pract Endocrinol Metab 3:92–102

    Article  PubMed  Google Scholar 

  8. Walz MK, Petersenn S, Koch JA et al (2005) Endoscopic treatment of large primary adrenal tumours. Br J Surg 92:719–723

    Article  PubMed  CAS  Google Scholar 

  9. Bonjer HJ, Lange JF, Kazemier G et al (1997) Comparison of three techniques for adrenalectomy. Br J Surg 84:679–682

    Article  PubMed  CAS  Google Scholar 

  10. Hanssen WEJ, Kuhry E, Casseres YA et al (2006) Safety and efficacy of endoscopic retroperitoneal adrenalectomy. Br J Surg 93:715–719

    Article  PubMed  CAS  Google Scholar 

  11. Walz MK, Alesina PF, Wenger FA et al (2006) Posterior retroperitoneoscopic adrenalectomy – results of 560 procedures in 520 patients. Surgery 140:943–950

    Article  PubMed  Google Scholar 

  12. Tiberio GAM, Baiocchi GL, Arru L et al (2008) Prospective randomized comparison of laparoscopic vs open adrenalectomy for sporadic pheochromocytoma. Surg Endosc 22:1435–1439

    Article  PubMed  Google Scholar 

  13. Salomon L, Rabii R, Soule M et al (2001) Experience with retroperitoneal laparoscopic adrenalectomy for pheochromocytoma. J Urol 165:1871–1874

    Article  PubMed  CAS  Google Scholar 

  14. Dudley NE, Harrison BJ (1999) Comparison of open posterior vs transperitoneal laparoscopic adrenalectomy. Br J Surg 86:656–660

    Article  PubMed  CAS  Google Scholar 

  15. Weingarten TN, Cata JP, O’Hara JF et al (2010) Comparison of two preoperative medical management strategies for laparoscopic resection of pheochromocytoma. Urology 76:508.e6–11

    PubMed  Google Scholar 

  16. Ulchaker JC, Goldfarb DA, Bravo EL, Novick AC (1999) Successful outcomes in pheochromocytoma surgery in the modern era. J Urol 161:764–767

    Article  PubMed  CAS  Google Scholar 

  17. Prys-Roberts C, Farndon JR (2002) Efficacy and safety of doxazosin for perioperative management of patients with pheochromocytoma. World J Surg 26:1037–1042

    Article  PubMed  Google Scholar 

  18. Bruynzeel H, Feelders RA, Groenland THN et al (2009) Risk factors for hemodynamic instability during surgery for pheochromocytoma. J Clin Endocrinol Metab 95:678–685

    Article  PubMed  Google Scholar 

  19. Lentschener C, Gaujoux S, Thillois JM et al (2009) Increased arterial pressure is not predictive of haemodynamic instability in patients undergoing adrenalectomy for phaeochromocytoma. Acta Anaesthesiol Scand 53:522–527

    Article  PubMed  CAS  Google Scholar 

  20. Weingarten TN, Sprung J (2011) Sometimes too much of a good thing may not be that good. Urology 78:478–479

    PubMed  Google Scholar 

  21. Pacak K (2007) Approach to the patient – Preoperative management of the pheochromocytoma patient. J Clin Endocrinol Metab 92:4069–4079

    Article  PubMed  CAS  Google Scholar 

  22. Kinney MAO, Narr BJ, Warner MA (2002) Perioperative management of pheochromocytoma. J Cardiothor Vasc Anesth 16:359–369

    Article  Google Scholar 

  23. Grosse H, Schröder D, Schober O et al (1990) Die Bedeutung einer hochdosierten α-Rezeptorenblockade für Blutvolumen und Hämodynamik beim Phäochromozytom. Anaesthesist 39:313–318

    PubMed  CAS  Google Scholar 

  24. Boutros AR, Bravo EL, Zanetti G, Straffon RA (1990) Perioperative management of 63 patients with pheochromocytoma. Cleve Clin J Med 57:613–617

    PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Anästhesiologie, Intensiv- und Schmerztherapie, Kliniken Essen-Mitte, Henricistr. 92, 45136, Essen, Deutschland

    H. Groeben

Authors
  1. H. Groeben
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Groeben.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Groeben, H. Präoperative α-Rezeptoren-Blockade beim Phäochromozytom? – Kontra. Chirurg 83, 551–554 (2012). https://doi.org/10.1007/s00104-011-2196-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-011-2196-3

Schlüsselwörter

Keywords

Search

Navigation