Effects of perioperative alpha1 block on haemodynamic control during laparoscopic surgery for phaeochromocytoma

Background. Laparoscopic surgery for phaeochromocytoma can cause excessive catecholamine release with severe hypertension and sinus tachycardia. I.V. calcium antagonists may be used to prevent increases in blood pressure during phaeochromocytoma resection. We investigated the effects of perioperative a1 adrenergic block with urapidil on intraoperative haemodynamic events. The aim was to block the a1 adrenergic receptors before any acute catecholamine release, to prevent any severe rise in blood pressure. Methods. Eighteen patients with a phaeochromocytoma received a continuous i.v. infusion of urapidil 10‐15 mg h ‐1 for 3 days before surgery and until the adrenal gland had been removed. Plasma catecholamine concentrations were measured before surgery, after induction of anaesthesia, at the end of pneumoperitoneal insufflation, during gland manipulation, after gland resection, and in the recovery room after extubation. Arterial pressure was recorded concomitantly. Hypertensive events were treated with boluses of nicardipine with or without esmolol. Results. All patients had the adrenal tumour removed without any severe rise in blood pressure or other complication. Creation of a pneumoperitoneum and adrenal gland manipulation induced significant catecholamine release associated with hypertension in 6 and 12 patients, respectively. No correlation was found between hypertensive events and plasma catecholamine levels suggesting a1 receptor block with urapidil is efficacious. Conclusions. Perioperative a1 block using i.v. urapidil is a safe and efficient alternative during surgical management of phaeochromocytoma. Br J Anaesth 2004; 92: 512‐17