We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Preoperative Amlodipine Is Efficacious in Preventing Intraoperative HDI in Pheochromocytoma: Pilot RCT.
- Authors
Kumar Jaiswal, Sanjeet; Samad Memon, Saba; Lila, Anurag; Sarathi, Vijaya; Goroshi, Manjunath; Garg, Robin; Barnabas, Rohit; Hemantkumar, Indrani; Patel, Rajendra D.; Oak, Shrikanta; Dalvi, Abhay; Garale, Mahadeo; Patil, Virendra; Shah, Nalini S.; Bandgar, Tushar; Jaiswal, Sanjeet Kumar; Memon, Saba Samad
- Abstract
<bold>Context: </bold>Preoperative blockade with α-blockers is recommended in patients with pheochromocytoma/paraganglioma (PPGL). The data on calcium channel blockade (CCB) in PPGL are scarce.<bold>Objective: </bold>We aimed to compare the efficacy of CCB and α-blockers on intraoperative hemodynamic instability (HDI) in PPGL.<bold>Methods: </bold>In the interim analysis of this monocentric, pilot, open-label, randomized controlled trial, patients with solitary, secretory, and nonmetastatic PPGL were randomized to oral prazosin gastrointestinal therapeutic system (GITS) (maximum 30 mg, n = 9) or amlodipine (maximum 20 mg, n = 11). The primary outcomes were the episodes and duration of hypertension (systolic blood pressure ≥ 160 mmHg) and hypotension (mean arterial pressure < 60 mmHg) and duration of HDI (hypertension and/or hypotension) as a percentage of total surgical time (from induction of anesthesia to skin closure).<bold>Results: </bold>The median (IQR) episodes (2 [1-3] vs 0 [0-1]; P = 0.002) and duration of hypertension (19 [14-42] vs 0 [0-3] minutes; P = 0.001) and intraoperative HDI duration (22.85 ± 18.4% vs 2.44 ± 2.4%; CI, 8.68-32.14%; P 0.002) were significantly higher in the prazosin GITS arm than the amlodipine arm, whereas episodes and duration of hypotension did not differ between the 2 groups. There was no perioperative mortality. One patient had intraoperative ST depression on the electrocardiogram. The drug-related adverse effects were pedal edema (1 in amlodipine), dizziness (1 in prazosin GITS), and tachycardia (6 in prazosin GITS and 3 in amlodipine).<bold>Conclusion: </bold>Preoperative blockade with amlodipine is an efficacious alternative to prazosin GITS in preventing intraoperative HDI in PPGL. Larger studies that compare preoperative blockade by amlodipine with other α-blockers like phenoxybenzamine and/or doxazosin in PPGL patients are warranted.
- Subjects
PHEOCHROMOCYTOMA; AMLODIPINE; CALCIUM antagonists; HEMODYNAMICS; BLOOD pressure; RESEARCH; RESEARCH methodology; MEDICAL cooperation; EVALUATION research; TREATMENT effectiveness; COMPARATIVE studies; RANDOMIZED controlled trials; ADRENAL tumors; INTRAOPERATIVE monitoring
- Publication
Journal of Clinical Endocrinology & Metabolism, 2021, Vol 106, Issue 8, pe2907
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/clinem/dgab231