Zusammenfassung
In den letzten 50 Jahren konnte die Mortalität im Rahmen der Resektion katecholaminproduzierender Tumoren erheblich gesenkt werden. Hierzu haben viele Faktoren wie die Entwicklungen der chirurgischen Technik, intraoperative Kreislaufüberwachung und Steuerung sowie eine verbesserte Diagnostik beigetragen. Häufig wird als maßgeblicher Faktor die perioperative Blockade der α-Rezeptoren benannt. Die Effektivität dieser Blockade wurde bisher in keiner Studie ausreichend überprüft. In vielen Studien wird trotz α-Rezeptor-Blockade von Blutdruckanstiegen weit über 200 mmHg berichtet.
Von 200 konsekutiven Resektionen haben wir 73 Patienten ohne α-Rezeptor-Blockade betreut und keinen signifikanten Unterschied in den maximalen intraoperativen Blutdruckwerten und der Blutdruckanstiege über 200 mmHg festgestellt. Außerdem ließ sich kein dosisabhängiger Effekt von Phenoxybenzamin auf den maximalen intraoperativen Blutdruck nachweisen.
Daher muss in Anbetracht der nicht unerheblichen Nebenwirkungen und des Zeitaufwands für die Titration einer α-Rezeptor-Blockade die Effektivität und der routinemäßige Einsatz dieser Blockade infrage gestellt werden.
Abstract
Perioperative mortality regarding the resection of catecholamine-producing tumors has been markedly improved. This improvement has been attributed to the preoperative treatment with α-receptor blocking agents. An α-receptor block is still recommended prior to the resection of pheochromocytoma or paraganglioma. However, the effect has never been tested in a randomized clinical trial. Despite an assumed effective α-receptor block, many centers report systolic blood pressure increases beyond 200 mmHg.
Out of 200 consecutive resections of catecholamine-producing tumors, 73 patients without an α-receptor blockade were treated. There was no significant difference in the maximum systolic blood pressure or in the incidence of hypertensive episodes. There was no correlation between the individual dose of phenoxybenzamine and the maximum blood pressure.
Overall it can be concluded that with the improvement of surgical techniques, diagnostic tools and highly effective short acting substances to control hemodynamics intraoperatively, the question must be raised whether a time-consuming, unreliable pretreatment burdened with significant side effects is still required.
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Groeben, H. Präoperative α-Rezeptoren-Blockade beim Phäochromozytom? – Kontra. Chirurg 83, 551–554 (2012). https://doi.org/10.1007/s00104-011-2196-3
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DOI: https://doi.org/10.1007/s00104-011-2196-3