Introduction: The Challenge of Hemodynamic Control in PPGL Resection
Patients undergoing resection of pheochromocytoma and paraganglioma (PPGL) present some of the most complex challenges in perioperative medicine. These catecholamine-secreting tumors can trigger profound hemodynamic volatility, characterized by hypertensive crises during tumor manipulation and sudden, severe hypotension following vessel ligation. Despite advances in preoperative alpha-adrenergic blockade and modern anesthetic techniques, intraoperative hemodynamic instability (IHI) remains a significant risk factor for cardiovascular complications, including myocardial ischemia, arrhythmias, and cerebrovascular events.
While various pharmacological agents such as phentolamine, nitroprusside, and short-acting beta-blockers are used to manage these surges, there has been increasing interest in preemptive strategies that stabilize the vascular bed before the surge occurs. Magnesium sulfate (MgSO4) has long been recognized in obstetric and cardiac anesthesia for its vasodilatory and anti-arrhythmic properties. However, high-quality, prospective evidence for its efficacy specifically in the context of PPGL resection has been limited until now.
