Which statement about intraoperative management of pheochromocytoma crisis is true?

Which statement about intraoperative management of pheochromocytoma crisis is true?

• A. Beta-blockade should be used only after adequate alpha-blockade.
• B. Beta-blockade is never used.
• C. Alpha-blockade is avoided.
• D. Vasopressors are never used.

Answer: (A)

In this scenario the main concept is the order of pharmacologic blockade during pheochromocytoma crisis. Catecholamine surges cause severe hypertension and tachycardia, so the first goal is to block alpha-adrenergic receptors to prevent vasoconstriction and lower vascular resistance. Only after achieving adequate alpha-blockade should a beta-blocker be added to control heart rate and protect the heart from ongoing catecholamine effects. The reason for this sequence is that giving a beta-blocker before alpha-blockade can leave alpha-driven vasoconstriction unopposed, potentially causing a dangerous spike in blood pressure and risk of myocardial ischemia. Other statements fail because alpha-blockade is not avoided, beta-blockade is not never used (it is used, just after alpha-blockade), and vasopressors can be necessary to treat hypotension after blockade or tumor manipulation, not never used.

In this scenario the main concept is the order of pharmacologic blockade during pheochromocytoma crisis. Catecholamine surges cause severe hypertension and tachycardia, so the first goal is to block alpha-adrenergic receptors to prevent vasoconstriction and lower vascular resistance. Only after achieving adequate alpha-blockade should a beta-blocker be added to control heart rate and protect the heart from ongoing catecholamine effects. The reason for this sequence is that giving a beta-blocker before alpha-blockade can leave alpha-driven vasoconstriction unopposed, potentially causing a dangerous spike in blood pressure and risk of myocardial ischemia. Other statements fail because alpha-blockade is not avoided, beta-blockade is not never used (it is used, just after alpha-blockade), and vasopressors can be necessary to treat hypotension after blockade or tumor manipulation, not never used.