A 40-year-old man with a 5 cm biochemically confirmed pheochromocytoma is scheduled for laparoscopic adrenalectomy. Which perioperative regimen is mandatory to prevent intraoperative hypertensive crisis?
- A Phenoxybenzamine for 10 to 14 days preoperatively, then add beta-blocker only after adequate alpha blockade ✓
- B Propranolol alone started one week preoperatively
- C Intravenous phentolamine infusion started on the day of surgery only
- D Lisinopril and amlodipine titrated to target BP one week preoperatively
Correct answer: A. Phenoxybenzamine for 10 to 14 days preoperatively, then add beta-blocker only after adequate alpha blockade
Explanation
Alpha blockade with phenoxybenzamine must be established first and continued for 10 to 14 days. Beta-blockers are added only after alpha blockade to avoid unopposed alpha-mediated vasoconstriction. Starting beta-blockers first can precipitate severe hypertension. IV phentolamine or ACE inhibitors alone are insufficient for chronic catecholamine excess.
Reference: Schwartz's Principles of Surgery, 11th ed.
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