Phenoxybenzamine: Old Wine in a Bright New Bottle-Taming the wild side of Phenoxybenzamine

Background:
Phenoxybenzamine (PBZ), a long-acting α-blocker, was once widely used in pediatric cardiac surgeries but fell out of favor due to concerns about systemic hypotension. In the context of developing countries and resource-limited settings, PBZ may offer a cost-effective and safe alternative when used in a controlled protocol.
Objective:
To evaluate the safety and efficacy of a PBZ-based vasoplegic strategy during cardiopulmonary bypass (CPB) in pediatric open-heart surgeries.
Materials and Methods:
A prospective observational study was conducted between 2015 and 2020 at a tertiary care cardiac center. A total of 520 pediatric patients undergoing open-heart surgery with CPB received PBZ as the primary vasodilator in combination with low-dose adrenaline. Hemodynamic data, ICU outcomes, and incidence of postoperative complications were analyzed.
Results:
The protocol achieved stable intraoperative perfusion without the need for additional vasopressors. Most patients were extubated on the same day, and the incidence of pulmonary arterial hypertension crisis was negligible (one case). Mortality was limited to 2.7%, and postoperative hypotension was effectively managed with fluid and adrenaline support.
Conclusion:
PBZ, when used in a structured intraoperative protocol, offers a safe, economical, and effective strategy for pediatric cardiac surgeries, especially in settings with limited access to newer vasoplegic agents.