Preoperative drug preparation with α-blockers as an integral component of perioperative anesthetic management of laparoscopic adrenalectomy in patients with pheochromocytoma

The objective. Introduction of improved scheme of using the preoperative oral α-blockers as an integral part of modern anesthetic management in patients with pheochromocytoma in the specialized endocrine center by using the algorithm staged perioperative hemodynamic management (SPOHM). Materials аnd methods. The comparison of hemodynamic parameters was performed at the following stages: the initial consultation, 24?48 hours before the operation and the preoperative room in the main group( 33 women with adrenal pheochromocytoma who were underwent video-assisted laparoscopic adrenalectomy) and the control group (33 women with adrenal pheochrmocytoma: 19(58 %) underwent laproscopic adrenalectomy and 14(42%) lumbotomy. The main group in the preoperative leadup recieved α-blockers orally over 14 days before admission to the specialized endocrine center; 24?48 hours before the operation the patents were shifted to the intensive care unit (ICU), where oral α-blockers were replaced by infusion of intravenous α-blockers with continuous monitoring of hemodynamics. The control group in the preoperative leadup recieved α-blockers orally(less than 5 days) without infusion of intravenous α-blockerspreoperatively. Results and discussion. All patients had significantly (p <0,001) elevated level of metanephrine in 24 urine. According to the SPOHM algorithm either doxazosin at a dose of (10,0+_1,0) mg once daily or urapidil at a dose (144,0+_11,2) mg twice daily were used at the first stage. The preoperative infusion controlled hypotensive therapy with urapidil at a dose 9,7+_1,9 mg/h and correction of hypovolemia by balanced crystalloid solutions and 10% solution of hydroxyethyl starch (HES) (200/0,5) were performed on the 2nd stage. It was noted that blood pressure in the control group for 24?48 hours prior to surgery and preoperative stage was significantly (p ?0,05) higher in comparison with the main group. Conclusions. Introduction of pre-operative α-blocker usage provides high efficiency and safety of patients in the preoperative period due to better hemodynamic control.