Traditional group in which the patients̕ hemodynamic adjustment will be conducted using orally or IV α₁ & β-adrenergic blockers [Prazosin (minipress): 0.5-20 mg/day, Propranolol (Inderal) :10-360 mg/day, Bisoprolol (Concor): 2.5-20 mg/day, Atenolol (Tenormin): 25-100 mg/day &/or Labetalol (Trandate)200-600 mg/day, Angiotensin Converting enzyme inhibitors ( ACE inhibitors ) & Angiotensin II receptor blockers ARBs e.g. Tritace 2.5-10 mg/day & Atacand 4-16 mg/day]

Dexmedetomidine-Magnesium Sulfate (Dex-MgSo₄) group: in which in addition to the orally prescribed drugs; on admission to the ICU, the Pheo-patient has serum-Mg level measurement & a bolus of 40 mg/kg MgSo₄ is given I.V. & may be repeated until the therapeutic level of MgSo₄ 2-4 mmol/Liter is reached. Dexmedetomidine sedation is started the evening prior to surgery by loading dose of 1µg/Kg followed by 0.2-0.7 µg/Kg/hour according to each patient

Pheochromocytoma

which in addition to the orally prescribed drugs; on admission to the ICU, the Pheo-patient has serum-Mg level measurement & a bolus of 40 mg/kg MgSo₄ is given I.V. & may be repeated until the therapeutic level of MgSo₄ 2-4 mmol/Liter is reached (7&10). Dexmedetomidine sedation is started the evening prior to surgery by loading dose of 1µg/Kg followed by 0.2-0.7 µg/Kg/hour according to each patient

Dexmedetomidine

1) Traditional group in which the patients̕ hemodynamic adjustment will be conducted using orally or IV α₁ & β-adrenergic blockers [Prazocin (minipress): 0.5-20 mg/day, Propranolol (Inderal) :10-360 mg/day, Bisoprolol (Concor): 2.5-20 mg/day, Atenolol (Tenormin): 25-100 mg/day &/or Labetalol (Trandate)200-600 mg/day, ACI & ACRB e.g. Tritace 2.5-10 mg/day & Atacand 4-16 mg/day]

General anesthetic

Dexmedetomidine as intravenous sedating agent

Department of Anesthesia and Pain medicine.National Cancer Institute

the Effect of Dexmedetomidine and Magnesium Sulfate in Open Resection of Pheochromocytoma

The Perioperative Use of Dexmedetomidine and Magnesium Sulfate Compared With Traditional Anesthetic Technique for Open Resection of Pheochromocytoma.

Ehab Hanafy Shaker

lecturer of anesthesia ,critical care and pain medicine

National Cancer Institute, Egypt

Phenoxybenzamine (capsules 10 mg, once to twice daily) is administered orally, starting 2-3 weeks before planned resection of PCC.

Phenoxybenzamine (slow release tablets 4 or 8 mg, once to twice daily) is administered orally, starting 2-3 weeks before planned resection of PCC.

Starting dosage of phenoxybenzamine in hypertensive subjects:20 mg q.d. (=10 mg b.i.d.) and in normotensive subjects 10 mg q.d. (in the evening). Dose escalation until blood pressure targets are reached, with a maximum dose of 140 mg q.d. (=70 mg b.i.d.)

Phenoxybenzamine

Starting dosage of doxazosine in hypertensive subjects:8 mg q.d. (=4 mg b.i.d.)and in normotensive subjects starting dose 4 mg q.d. (in the evening). Dose escalation until blood pressure targets are reached, with a maximum dose of 48 mg q.d. .(=24 mg b.i.d.)

Doxazosin

Department of Endocrinology, University Medical Center Groningen

Phenoxybenzamine Versus Doxazosin in PCC Patients

Pheochromocytoma Randomised Study Comparing Adrenoreceptor Inhibiting Agents for Preoperative Treatment

Blood pressure and heart rate will be monitored continuesly during surgery.

success rate of doxazosin and phenoxybenzamine to attain preoperative blood pressure target values without co-medication

Resulution of headache, palpitations, sweeting, paleness, nausea, flushes, fatigue and anxiety.

Assessment of the number of patients who need additional antihypertensive drugs on top of the study drugs

Adverse effects of doxazosin or phenoxybenzamine

Comparing duration of preoperative treatment in either outpatient or inpatient clinic

number of episodes with systolic blood pressure (SBP) > 160 mmHg
number of episodes with mean arterial blood pressure (MAP) < 60 mmHg
duration (in minutes) of SBP > 160 mmHg
duration (in minutes) of MAP < 60 mmHg
number of episodes with heart rate > 100/min
duration (in minutes) of heart rate > 100/min
amount and type of vasoactive agents needed during surgery for adequate blood pressure control.
cumulative amount and type of intravenous fluids administered

Number of days the patient is staying in the hospital before and after surgery

Composite semi-quantitative score of intra- and postoperative hemodynamic control based on the following parameters:
blood pressure and heart rate outside target range
need for administration of vasoactive agents
need for administration of intravenous fluids

Frequency and severity (in mmol/L)of hypoglycaemia during first 24 hours after surgery.

Death from any cause occurring during period from first administration of study medication until 30 days after surgery.

Cardiovascular events occurring during period from first administration of study medication until 30 days after surgery. Cardiovascular events are: myocardial infarction, cardiac arrhythmia requiring medical intervention, heart failure, cerebrovascular ischemia, cerebrovascular haemorrhage.

Death from any cause occurring or cardiovascular events occurring during period from first administration of study medication until 30 days after surgery.

multiple endocrine neoplasia/edema

the Effect of Dexmedetomidine and Magnesium Sulfate in Open Resection of Pheochromocytoma

Phenoxybenzamine Versus Doxazosin in PCC Patients

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