Question

Drug of choice for pheochromocytoma during surgery is:

• A. Phentolamine
• B. Phenoxybenzamine
• C. Propranolol
• D. Prazosin

Hint:

Think about which alpha blocker has a short, titratable action suitable for acute intraoperative use.

Answer 1

The Correct Option is A

Pheochromocytoma -- Intraoperative Pharmacology

During surgical removal of a pheochromocytoma, handling of the tumor releases massive catecholamine surges causing acute hypertensive crises. The drug must work rapidly and be titratable.

Drug comparison table:

• Phentolamine -- non-selective competitive alpha blocker, IV bolus 2-5 mg, onset within 2 minutes, duration 10-15 minutes. Drug of choice intraoperatively.
• Phenoxybenzamine -- non-selective irreversible alpha blocker, used for preoperative preparation (10-14 days). Too long-acting for acute intraoperative use.
• Propranolol -- beta blocker, added only after alpha blockade to control reflex tachycardia. Never used alone (risk of unopposed alpha stimulation).
• Prazosin -- selective alpha-1 blocker, alternative for preoperative preparation only.

\[\boxed{\text{Phentolamine is the drug of choice during pheochromocytoma surgery}}\]