Adrenergic blockade

Traditionally, a combination of peripherally acting a- and b-receptor blockers have been used. Phenoxybenzamine, phentolamine, bethanidine, and chlorpromazine can block a receptors. Chlorpromazine is probably the best because of its additional central sedative effects. Propranolol (pure b-receptor blocker) and labetalol (a-and b-receptor blocker) have had limited success. We do not advise unopposed b-blockade as deaths from acute congestive cardiac failure have occurred. Removal of b-mediated vasodilatation in the muscle causes a rise in systemic vascular resistance, and the b-blocked myocardium may not be able to maintain cardiac output. The short-acting intravenous b-blocker esmolol is useful for controlling the tachycardia and hypertension of the crises; however, catecholamine levels remain raised (Lipman jnd Oh This is worrying because excessive catecholamine secretion is associated with myocardial damage.

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