O159 Nonselective alpha blockade alone is associated with a significant decrease in ICU/CCU requirement following phaeochromocytoma resection

Abstract

Abstract Introduction Preoperative treatment with alpha blockade is key to optimisation of patients with phaeochromocytoma. Beta blockers may be employed after optimal alpha blockade to prevent reflex tachycardia. The principle of treatment is to avoid severe intraoperative hypertension or hypotension, but the optimal perioperative regimen is unclear. Recent studies have suggested that dual blockade may increase the rate of intraoperative haemodynamic instability We hypothesized that nonselective alpha blockade alone, without addition of beta blockers, would reduce the need for postoperative ICU/CCU supportive care. Methods A retrospective study of all patients undergoing pheochromocytoma/paraganglioma resection between 1998 and 2022 was performed. Patients were categorized into two cohorts: Group 1 patients received alpha and beta blockers preoperatively while Group 2 patients received nonselective alpha blockade alone. The primary endpoint was the need for ICU/CCU support. Results Of 40 patients identified, adrenalectomy was performed in 36. Median age at resection was similar for both groups (63 v 56 years). Of 22 Group 1 patients 8 (36.4%) required ICU/CCU admission due to haemodynamic instability, (MLS 1.22 days) compared to 3 (21.4%) of the 14 Group 2 (MLS 0.21, p=0.035; one-tailed Two-Sample t-test assuming unequal variance). Median maximum diameter of lesions in Group 1 was 5.4cm, while Group 2 was 4.2cm. In Group 1 59% showed right adrenal disease (n=13), Group 2 43% (n=6). Conclusion Our study suggests that nonselective alpha blocker alone, without the addition of beta blockers, is associated with a significantly decreased requirement for post-operative support in the ICU or CCU following pheochromocytoma resection.