Perioperative management for pheochromocytoma
The goal of preoperative medical therapy is to control blood pressure (for 1 to 4 weeks prior to surgery) and to block the cardiovascular consequences of increased catecholamine levels.
Alpha-blockers should be given first; phenoxybenzamine, a long-acting, oral, noncompetitive alpha-blocker, is preferred. The more selective, competitive, postsynaptic alpha 1 -blockers (prazosin, terazosin, doxazosin) have a shorter duration of action and provide incomplete α-blockade, so failures have been described. When tachycardia or cardiac dysrhythmias persist, a β-adrenergic blocker may be given, but only after achieving α-blockade to avoid unopposed α-receptor stimulation and further vasoconstriction.
