Does a large hemangioma affecting the right breast gland, treated with Inderal (Propranolol), require admission?

From the Guidelines

Admission is typically not necessary for treating a large hemangioma affecting the right breast gland with Inderal (propranolol). This condition can usually be managed on an outpatient basis, as propranolol has been shown to be efficacious in reducing the size and color intensity of infantile hemangiomas (IH) when administered orally at a dose of 1 to 3.4 mg/kg per day 1. The mechanism of propranolol’s effect on IH likely involves several processes, including vasoconstriction, inhibition of angiogenesis, and stimulation of apoptosis 1.

When treating a large hemangioma with propranolol, it is essential to:

• Start with a dose of 1-3 mg/kg/day divided into 2-3 doses
• Gradually increase the dose over 1-2 weeks to a target of 2-3 mg/kg/day
• Continue treatment for 6-12 months, with regular follow-up appointments to monitor progress Before initiating treatment, patients should undergo:

1. A baseline ECG
2. Blood pressure measurement
3. Heart rate check
4. Blood glucose level test During treatment, monitor for potential side effects such as:

• Hypoglycemia
• Bradycardia
• Hypotension
• Sleep disturbances It is crucial to note that contraindications to the use of propranolol for IH include cardiogenic shock, sinus bradycardia, hypotension, heart block greater than first-degree, heart failure, bronchial asthma, and known hypersensitivity to the drug 1. While outpatient management is typical, admission may be considered in rare cases with complications or if close monitoring is required during treatment initiation.

From the Research

Hemangioma Treatment with Inderal (Propranolol)

• The provided studies do not directly address the treatment of a large hemangioma affecting the right breast gland with Inderal (Propranolol) or the necessity of admission for such treatment 2, 3, 4, 5, 6.
• However, some studies discuss the importance of monitoring in various medical contexts, such as clinical trials 2, anticoagulant therapy 3, upper airway surgery for obstructive sleep apnoea 4, and liver resection 5.
• Additionally, a study reviews hemodynamic monitoring techniques and devices for emergency physicians, highlighting the importance of assessing cardiovascular system performance and determining the correct therapeutic intervention 6.

Monitoring and Admission

• The study on upper airway surgery for obstructive sleep apnoea suggests that routine post-operative admission to an intensive care unit is unnecessary for all patients, but close monitoring in the post-anaesthesia care area is recommended 4.
• The study on liver resection found that patients who underwent major liver resection and received intraoperative transfusions were more likely to require ICU admission and intensive medical treatment 5.
• However, these findings may not be directly applicable to the treatment of a large hemangioma with Inderal (Propranolol), as the studies address different medical conditions and contexts.