A 38-year-old woman is diagnosed with a 5-cm right adrenal pheochromocytoma after presenting with episodic palpitations, diaphoresis, and severe headaches. Her clinic blood pressure is 168/102 mmHg, and her heart rate is 105/min. She is scheduled to undergo a laparoscopic adrenalectomy in 3 weeks. Arrange the following perioperative management steps in the correct chronological sequence to appropriately prepare this patient for surgery and minimize the risk of intraoperative hemodynamic instability.
- 1Initiate non-selective alpha-adrenergic blockade (e.g., phenoxybenzamine)
- 2Liberalize dietary sodium and encourage high fluid intake
- 3Initiate beta-adrenergic blockade (e.g., propranolol)
- 4Perform surgical resection of the adrenal mass
Cevap
The correct sequence is: Alpha-adrenergic blockade, followed by sodium and fluid loading, followed by beta-adrenergic blockade, and finally surgical resection.
The preoperative management of pheochromocytoma requires a strict sequence to prevent life-threatening hemodynamic instability. Alpha-blockade must be initiated first to relieve chronic vasoconstriction. This unmasks underlying volume depletion, allowing the contracted intravascular space to be expanded with liberal sodium and fluids. Only after adequate alpha-blockade can beta-blockers be introduced to control tachycardia. Definitive surgery is the final step.
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Preoperative pharmacological preparation sequence for pheochromocytoma