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Preoperative Amlodipine Is Efficacious in Preventing Intraoperative HDI in Pheochromocytoma: Pilot RCT
Sanjeet Kumar Jaiswal1, Saba Samad Memon1, Anurag Lila1
1Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra 400012,India.
The Journal of Clinical Endocrinology and Metabolism
|April 11, 2021
Summary
Amlodipine effectively prevents intraoperative hemodynamic instability in pheochromocytoma/paraganglioma (PPGL) surgery, offering a viable alternative to alpha-blockers like prazosin. This finding suggests amlodipine as a potential standard for PPGL patient preparation.
Area of Science:
- Endocrinology
- Cardiovascular Pharmacology
- Surgical Anesthesia
Background:
- Preoperative alpha-blocker blockade is standard for pheochromocytoma/paraganglioma (PPGL) surgery.
- Data on calcium channel blockers (CCBs) for PPGL intraoperative hemodynamic instability (HDI) are limited.
Purpose of the Study:
- To compare the efficacy of CCBs versus alpha-blockers in mitigating intraoperative hemodynamic instability during PPGL surgery.
Main Methods:
- Pilot, open-label, randomized controlled trial comparing oral prazosin GITS with amlodipine in PPGL patients.
- Primary outcomes included episodes and duration of hypertension and hypotension, and overall HDI duration relative to surgical time.
Main Results:
- Amlodipine significantly reduced episodes and duration of hypertension and overall intraoperative HDI compared to prazosin GITS.
- No significant difference was observed in hypotension episodes or duration between the groups.
- Adverse effects were generally mild and comparable, with tachycardia noted more in the prazosin GITS group.
Conclusions:
- Preoperative amlodipine blockade is an effective alternative to prazosin GITS for preventing intraoperative HDI in PPGL patients.
- Further research comparing amlodipine with other alpha-blockers (e.g., phenoxybenzamine, doxazosin) is warranted.
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