Update in perioperative anesthetic management of pheochromocytoma

Table 1 Drugs commonly used in preoperative preparation of pheochromocytoma

Drug name	Dosages	Additional information
Phenoxybenzamine	60-50 mg	Dizziness, headache, nasal stuffiness peripheral edema and prolonged hypotension (long postoperative blockade)
Doxazosin	2-6 mg	Short acting, no prolonged hypotension
Beta blockers
Propranolol	80-120 mg	Careful in patients with asthma, conduction disturbances, severe heart failure. May cause severe bradycardia and postural hypotension
Metoprolol	50-100 mg
Labetalol	5-10 mg q5 min
Calcium channel blockers
Verapamil	120-240 mg	Careful in patients with n AV blocks, hypovolemia, sinus sick syndrome, and heart failure
Diltiazem	180 mg
Nifedipine	30-90 mg	Side effects: Elevated liver enzymes, headache, constipation, dizziness, fatigue, edema
Clonidine	0.1-1.2 mg
Dexmedetomidine	1 mg/kg in 10 min, 0.7 mg/kg per hour infusion	Dizziness, rebound hypertension side effects: depression, anxiety, dry mouth, bradycardia
Magnesium sulfate	1-8 mg loading dose, 1-4 mg/h maint	Potentiates neuromuscular blockade, caution in heart block and renal failure
Urapidil	10-15 mg/h	Caution because of severe hypotension
Alpha methyl-p-tyrosine	1-4 g/d	Crystaluria, extra-pyramidal and psychic disturbances

Table 2 Commonly used drugs during resection of pheochromocytoma

Drug	Dosages	Additional information
Fenoldopam	0.2 mg/kg per minute	Tachycardia, hypokalemia
		Cautions in patients with CVA
Sodium nitroprusside	1-2 mg/kg per minute	Cyanide toxicity, reflex tachycardia, severe hypotension
Nitroglycerine	25-250 mg/min	Reflex tachycardia, tachyphylaxis
		Methemoglobinemia, cerebral vazodilation
Nicardipine	5.0 mg/h	Hypotension, bradycardia, heart failure, WPW syndrome
Phentolamine	1-5 mg	Minimum side effects
Beta blockers		Careful in patients with asthma, conduction disturbances, severe heart failure. May cause severe bradycardia and postural hypotension. May potentiate effect of other drugs (like CCB)
Esmolol	5-10 mg × 3 min
Metoprolol	2.5-5 mg × 2 min
Labetalol	5-10 mg
Epinephrine	1-20 mg/min	Α and β agonist, positive inotropic, chronotropic effect and increases BP
Norepinephrine	1-30 mg/min	α/β1 agonist, decreases organ blood flow
Dopamine	5-20 mg/kg per minute	α/β/dopamine dose dependent agonist, may cause tachycardia and dysrthymias
Vasopressin	0.1-0.4 units/min	May cause MI