A patient with known phaeochromocytoma is undergoing laparoscopic adrenalectomy. Despite adequate preoperative alpha-blockade with phenoxybenzamine, intraoperative hypertensive crisis occurs during tumour manipulation. The drug of choice for acute blood pressure control in this situation is:
- A Labetalol IV, because it provides both alpha and beta blockade simultaneously
- B Esmolol IV, a short-acting beta-blocker to control hypertension and tachycardia
- C Sodium nitroprusside infusion as the preferred agent due to its immediate onset
- D Phentolamine IV, a competitive short-acting alpha-blocker providing titratable response ✓
Explanation
Intraoperative hypertensive crises during phaeochromocytoma resection are driven by massive catecholamine release from tumour manipulation. Phentolamine — a competitive, short-acting alpha-adrenoceptor blocker — is the traditional agent of choice because it directly counteracts the alpha-adrenergic vasoconstriction of noradrenaline and adrenaline with rapid, titratable effect. Beta-blockers (esmolol, labetalol) must not be given before adequate alpha-blockade because unopposed alpha stimulation will worsen hypertension. Nitroprusside is an acceptable alternative with rapid offset, but phentolamine is the classic first-line agent for acute intraoperative phaeochromocytoma hypertension.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.