Purpose: Alpha-adrenergic blockers are used in the preoperative preparation of patients with pheochromocytomas and paragangliomas (PPGLs) despite the controversial on perioperative hemodynamics. We aimed to determine whether selective or non-selective α-adrenergic blockers can provide better efficacy on patients’ intraoperative hemodynamics.
Patients and Methods: This single-center retrospective study was conducted in 2507 adult patients undergoing PPGL resections, patients received alpha-adrenergic receptor blockers as a binary variable (selective or non-selective). Propensity score matching was performed and 201 patients were matched successfully.
Results: A total of 201 patients with PPGL were included in this study. The HI score scores were higher in the selective group than in the non-selective group (60.5 [44.5– 84.0] vs 49.0 [37.0– 67.25], P=0.027), as well as in the hemodynamic variables section [14.0 [8.0– 20.0] vs 10 [6.0– 16.0], P=0.009). In terms of specific indicators for each component, the lowest MAP in the selective group (55± 10 mmHg vs 59± 8 mmHg, P=0.038), the time to MAP below 60 mmHg (0.011% vs 0.022%, P=0.033) and the use of other vasoconstrictors (56.5% vs 35.5%, P=0.019) were significantly lower than in the non-selective group. Among the secondary outcome indicators, the incidence of intraoperative maximum SBP was significantly higher in the selective group than in the non-selective group (32.3% vs 11.3%, P=0.005). There were no significant differences in postoperative outcome indicators between the two groups.
Conclusion: In patients with PPGL, patients prepared preoperatively with non-selective alpha-blockers presented more stable hemodynamics intraoperatively compared to selective alpha1-blockers.
Keywords: α-adrenergic blockers, PPGLs, hemodynamic instability, perioperative management