Southern medical journal
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Southern medical journal · Feb 1982
ReviewPharmacologic agents in the management of pheochromocytoma.
Medical management of pheochromocytoma involves the use of many therapeutic agents. Phenoxybenzamine HCl (Dibenzyline), an alpha-adrenergic blocking agent, at 40 to 80 mg per day can control the disease in most patients. Use of this drug up to the time of operation is controversial. ⋯ Alpha-methylparatyrosine (Metyrosine), which decreases catecholamine synthesis, is a new drug recently released for the treatment of pheochromocytoma when surgery is contraindicated or in cases of malignant pheochromocytoma. The use of a combination of anesthetic agents, such as nitrous oxide, thiopental, narcotics, and enflurane, ensures smooth induction of anesthesia in most cases. Careful and prompt control of hypertensive crises with sodium nitroprusside and of arrhythmias with propranolol and lidocaine are critical to the success of surgery.
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Management of the airway in acute epiglottitis is still controversial. One argument against intubation as opposed to tracheostomy is the increased complications from prolonged intubation. ⋯ Included in this series are 16 consecutive patients who were treated by nasotracheal intubation and simultaneous medical therapy. Fifteen of the 16 patients extubated safely in less than 48 hours, significantly decreasing the possibility for complications.