Calcium channel blockade and uncontrolled blood pressure during phaeochromocytoma surgery

Phaeochromocytoma has traditionally been managed by preoperative adrenergic blockade followed by surgical devascularization and excision. Recently, various studies have reported the use of calcium channel blocking drug therapy, either as monotherapy or in combination with other non-adrenergic blocking antihypertensive medications for blood pressure control in the preoperative management of phaeochromocytoma. In this case report, diltiazem as monotherapy was used to establish adequate preoperative blood pressure control in a patient with metastatic phaeochromocytoma to the liver. During cryoablation therapy surgery of the liver metastasis, the patient demonstrated extreme blood pressure lability requiring nitroprusside and high end tidal concentrations of isoflurane for blood pressure control. This case report suggests that during resection of a phaeochromocytoma where tumour devascularization is not obtainable, calcium channel blocking drugs as monotherapy may be inadequate to control blood pressure extremes. The authors suggest that under clinical circumstances reported above strong consideration be given to the use of standard adrenergic blocking drug therapy pre- and intraoperatively.