{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T01:50:16Z","timestamp":1783648216774,"version":"3.55.0"},"reference-count":23,"publisher":"Royal College of Surgeons of England","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["annals"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p> Phaeochromocytomas\/paraganglioma (PPGL) surgery was historically associated with significant risks of perioperative complications. The decreased mortality (&lt;3.0%) had been attributed in part to optimal preoperative alpha-blockade. The value of alpha-blockade in decreasing morbidity is being challenged. The aim of our study is to present an institutional experience of preoperative alpha-blocking of PPGL and its effect on cardiovascular stability and postoperative morbidity. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> A retrospective study using data from our institutional database was conducted. All patients undergoing adrenalectomy for PPGL from October 2011 to September 2020 were included. All patients were routinely alpha-blocked. Intraoperative cardiovascular instability (ICI) was assessed through number of systolic blood pressure (SBP) episodes &gt;160mmHg, SBP &lt;90mmHg, the need for vasoactive drugs and volume of intraoperative crystalloids administered. Morbidity was also evaluated. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> A total of 100 consecutive patients undergoing surgery were identified of whom 53 patients had complete anaesthetic records available for analysis. Thirty-two patients (60%) had at least one episode with an SBP &gt;160mmHg. Nine (17%) cases had no intraoperative hypotensive episodes, while 3 (6%) patients had &gt;10 intraoperative episodes of an SBP &lt;90mmHg. Twenty-one (40%) patients received vasoactive drugs during surgery. The median volume of intraoperative crystalloids was 2 litres (1\u20134). Postoperatively, no patient experienced cardiovascular complications, including arrhythmia or myocardial ischaemia. Only two were admitted to an intensive care unit (ICU) and one 30-day readmission occurred. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p> Cardiac instability remained significant in PPGL surgery despite optimal alpha- and beta-blockade. While omitting blockade would appear empirically questionable, a randomised controlled trial (RCT) of surgery with and without alpha-blockade will provide an answer. <\/jats:p><\/jats:sec>","DOI":"10.1308\/rcsann.2021.0133","type":"journal-article","created":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T10:41:04Z","timestamp":1684147264000},"page":"138-143","source":"Crossref","is-referenced-by-count":10,"title":["To block, or not to block\u2009\u2026\u2009is it still the question? 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