How is pheochromocytoma prepared for surgery?
A patient may require 5–15 days of preoperative preparation with optimal alpha blocking drugs, increased oral fluids and salt intake and/or intravenous fluids before being “accepted” for surgery.
Is morphine contraindicated in pheochromocytoma?
Drugs that increase sympathetic tone such as ketamine, ephedrine, pancuronium, metoclopramide should not be used in patients with pheochromocytoma [22]. Histamine provoking drugs such as morphine and atracurium should also be avoided.
Why do we give alpha blocker first in pheochromocytoma?
Pheochromocytoma is a rare, catecholamine (ex. adrenaline) secreting tumor that requires preoperative alpha blockade to minimize intraoperative hemodynamic instability, thereby reducing intra- and postoperative morbidity and mortality.
What are 4 possible treatments for pheochromocytoma?
The primary treatment for a pheochromocytoma is surgery to remove the tumor….Cancer treatments
- MIBG .
- Peptide receptor radionuclide therapy (PRRT).
- Chemotherapy.
- Radiation therapy.
- Targeted cancer therapies.
What is the survival rate of pheochromocytoma?
Patients with a small pheochromocytoma that has not spread to other parts of the body have a five-year survival rate of about 95%. Patients with pheochromocytoma that has grown back (recurred) or spread to other parts of the body have a five-year survival rate between 34% and 60%.
Which medication is indicated for a patient with a pheochromocytoma?
Labetalol (Trandate, Normodyne) is a noncardioselective beta-adrenergic blocker and selective alpha-adrenergic blocker that has been shown to be effective in controlling hypertension associated with pheochromocytoma.
How do you investigate for pheochromocytoma?
Diagnosis of pheochromocytoma
- Use plasma metanephrine testing in patients at high risk (ie, those with predisposing genetic syndromes or a family or personal history of pheochromocytoma)
- Use 24-hour urinary collection for catecholamines and metanephrines in patients at lower risk.
What if a patient with pheochromocytoma is given a beta blocker before alpha blocker?
Beta-blockers must never be started prior to adequate alpha-blockade, since in the absence of beta-2-mediated vasodilation, profound unopposed alpha-mediated vasoconstriction may lead to hypertensive crisis or pulmonary edema.
Which treatment is given to a patient with pheochromocytoma to control high BP before surgery?
Thus, its use in the preoperative treatment of patients with pheochromocytoma is controversial. During surgery, intravenous phentolamine, a rapid-acting alpha-adrenergic antagonist, is used to control blood pressure. Rapid-acting intravenous beta blockers, such as esmolol, are also used to normalize blood pressure.