Preoperative amlodipine is efficacious in preventing intraop
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Preoperative blockade with α-blockers is recommended in patients with pheochromocytoma/paraganglioma (PPGL). The data on calcium channel blockade (CCB) in PPGL is scarce. Researchers aimed to compare the efficacy of CCB and α-blockers on intraoperative haemodynamic instability (HDI) in PPGL.

In the interim analysis of this monocentric, pilot, open-label, randomized controlled trial, patients with solitary, secretory, and nonmetastatic PPGL were randomized to oral prazosin GITS (maximum 30mg, n=9) or amlodipine (maximum 20mg, n=11). The primary outcomes were the episodes and duration of hypertension (SBP more than 160mmHg) and hypotension (MAP less than 60mmHg) and duration of HDI (hypertension and/or hypotension) as a percentage of total surgical time (from induction of anesthesia to skin closure).

Findings:
-- The median episodes (2 vs. 0) and duration of hypertension (19 min vs. 0 min) and intraoperative HDI duration (22·85±18.4% vs 2·44±2·4%) were significantly higher in the prazosin GITS arm than the amlodipine arm whereas episodes and duration of hypotension did not differ between the two groups.

-- There was no perioperative mortality whereas one patient had intraoperative ST depression on the electrocardiogram.

-- The drug-related adverse effects were pedal edema (1 in amlodipine), dizziness (1 in prazosin GITS), and tachycardia (6 in prazosin GITS and 3 in amlodipine).

Preoperative blockade with amlodipine is an efficacious alternative to prazosin GITS in preventing intraoperative HDI in PPGL. Larger studies that compare preoperative blockade by amlodipine with other α-blockers like phenoxybenzamine and/or doxazosin in PPGL patients are warranted.

Source: https://academic.oup.com/jcem/advance-article-abstract/doi/10.1210/clinem/dgab231/6220317?redirectedFrom=fulltext
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