Generally, little specific pre-op care for adrenalectomy is needed. If the patient smokes, stopping for even a few days can help minimize airway irritation and coughing. Generally, the patient should continue all of their pre-op medication including aspirin. Coumadin, a common blood thinner, should be discontinued at least 5 days before the surgery. We’ll discuss these issues in detail at your initial consultation. The patient should not eat or drink anything after midnight the day before surgery. If the patient is on high blood pressure medication it should be taken with a small sip of water the morning of surgery. If the patient is diabetic we don’t want them to take their oral medication or insulin the morning of surgery.
Depending on the diagnosis, some specific pre-op preparation may be required. Patients with Conn’s syndrome should have their high blood pressure reasonably controlled and potassium replaced. Patients with Cushing’s syndrome don’t usually require any specific preparation other than reasonable blood pressure control.
Pheochromocytoma is a special situation. The over production of catecholamines may create dangerously high blood pressure or cardiac instability with the induction of anesthesia. During the surgery, manipulation of the tumor may cause sudden and severe fluctuations in blood pressure. Because of these issues, pre-op administration of medication that counteracts the over production of these hormones is necessary. Adequate preparation usually takes about 2 weeks. The goal of this therapy is to reduce the pulse rate and blood pressure to near normal levels. We typically use phenoxybenzamine in increasing doses to reduce blood pressure and counteract the effects of elevated catecholamines . If the blood pressure is controlled but the pulse is still elevated we may add labetalol. During this time the patient is encouraged to take in significant fluids to minimize low blood pressure after the surgery. With proper preparation surgery for pheochromocytoma is relatively safe.