Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Perioperative mortality regarding the resection of catecholamine-producing tumors has been markedly improved. This improvement has been attributed to the preoperative treatment with α-receptor blocking agents. An α-receptor block is still recommended prior to the resection of pheochromocytoma or paraganglioma. ⋯ There was no significant difference in the maximum systolic blood pressure or in the incidence of hypertensive episodes. There was no correlation between the individual dose of phenoxybenzamine and the maximum blood pressure. Overall it can be concluded that with the improvement of surgical techniques, diagnostic tools and highly effective short acting substances to control hemodynamics intraoperatively, the question must be raised whether a time-consuming, unreliable pretreatment burdened with significant side effects is still required.
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The common practice to stop therapy with acetylsalicylic acid (aspirin) and/or clopidogrel perioperatively is critically discussed in the literature. There are no generally accepted guidelines for the handling of this problem. In this article the present strategy of perioperative antiplatelet therapy applied in German thoracic surgery departments was investigated. ⋯ The survey showed that in Germany the majority of thoracic surgeons reduce or stop antiplatelet therapy (given as secondary prophylaxis) before surgical procedures. It can be assumed that patients are therefore exposed to an increased risk of cardiovascular morbidity and mortality.