Preoperative treatment for surgical resection of a pheochromocytoma:
a) Should be accomplished within 48 hours to minimize risk of hypertensive urgency
b) Should consist of beta-blockade followed by alpha-blockade
c) Has reduced perioperative mortality from 20% to 0-4%
d) Is not necessary prior to anesthesia for imaging studies to localize tumor
Answer c. Pheochromocytomas are slow growing, and surgical resection and localization by imaging studies is not more urgent than proper pre-anesthetic alpha-blockade, which has been shown to significantly reduce mortality. Betablockade should not be used until after adequate alpha-blockade is achieved to prevent unopposed alpha-mediated vasoconstriction and severe hypertension. Though tumor manipulation will not occur during imaging studies, induction, laryngoscopy and even radiocontrast dye have all precipitated massive catecholamine surges. All anesthetics, including for imaging, given to patients with known or suspected pheochromocytoma should involve planning and preparation for significant hemodynamic dysregulation.