Association of 5-aminolevulinic acid with intraoperative hypotension in malignant glioma surgery

Morisawa, Shumpei; Jobu, Kohei; Ishida, Takanobu; Kawada, Kei; Fukuda, Hitoshi; Kawanishi, Yu; Nakayama, Taku; Yamamoto, Shinkuro; Tamura, Naohisa; Takemura, Mitsuhiro; Kagimoto, Nao; Ohta, Tsuyoshi; Masahira, Noritaka; Fukuhara, Hideo; Ogura, Shun‐ichiro; Ueba, Tetsuya; Inoue, Keiji; Miyamura, Mitsuhiko

doi:10.1016/j.pdpdt.2021.102657

Cited by 9 publications

(9 citation statements)

References 52 publications

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“…Morisawa et al reported that treatment of HUVEC cells with 5-ALA increased NO metabolites. 19 5-ALA relaxes peripheral blood vessels via the NO-sGC-cGMP system and may reduce systemic arterial pressure in patients taking 5-ALA. Although blood pressure generally rises after waking up, this study revealed that the rise of blood pressure from awakening to anesthesia induction was significantly poor in patients who took oral 5-ALA by comparing those who underwent PDD-TURBT versus conv-TURBT.…”

Section: Discussionmentioning

confidence: 99%

Incidence and predictors of intraoperative hypotension during transurethral bladder tumor resection with oral 5‐aminolevulinic acid

Ishikawa,

Tanaka,

Fujiwara

et al. 2023

Int J of Urology

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ObjectivesTo analyze the incidence and risk factors of intraoperative hypotension related to photodynamic diagnosis‐assisted transurethral resection of bladder tumor (PDD‐TURBT) with oral 5‐aminolevulinic acid (5‐ALA).MethodsWe retrospectively analyzed 487 patients with bladder tumors who underwent PDD‐TURBT (n = 184) or conventional TURBT (conv‐TURBT) (n = 303) between 2018 and 2021. Intraoperative hypotension was defined as hypotension requiring vasopressors during TURBT, and its incidence was compared between the two groups. Potential risk factors of intraoperative hypotension, including preoperative change in mean arterial pressure (MAP), were further investigated in patients receiving PDD‐TURBT.ResultsThe median age was 72 years, 392 patients (81%) were male, and 203 (42%) had hypertension. TURBT was performed under general and spinal anesthesia in 76 (16%) and 411 (84%) patients, respectively. The incidence of intraoperative hypotension was significantly higher in PDD‐TURBT compared to conv‐TURBT (43% vs. 17%, respectively). The median change in MAP until the induction of anesthesia was +6.5 mmHg (range: −29.0 to +46.3) in the PDD‐TURBT group and +14.7 mmHg (range: −35.3 to +67.7) in the conv‐TURBT group, showing a significantly smaller increase in the PDD‐TURBT group (p < 0.001). In the multivariable analysis for PDD‐TURBT patients, advanced age, general anesthesia, and lower MAP change (<+6.5 mmHg) until anesthesia induction were significantly associated with intraoperative hypotension (p = 0.0104, <0.001, and <0.001, respectively).ConclusionsIntraoperative hypotension occurred more frequently in patients who underwent PDD‐TURBT than in those who underwent conv‐TURBT. Using oral 5‐ALA decreases preoperative blood pressure elevation and may be responsible for intraoperative hypotension.

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Section: Discussionmentioning

confidence: 99%

Incidence and predictors of intraoperative hypotension during transurethral bladder tumor resection with oral 5‐aminolevulinic acid

Ishikawa,

Tanaka,

Fujiwara

et al. 2023

Int J of Urology

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“…However, intraoperative hypotension is a common side effect of 5-ALA [ 9 – 11 ]. Several cases of severe and catecholamine-resistant hypotension have been reported [ 6 , 9 , 12 ]. One retrospective study showed that the prevalence of postinduction hypotension after 5-ALA administration was 70% in TURBT and craniotomy [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although the precise mechanisms of intraoperative hypotension following 5-ALA administration are unknown, its association with NO production in vascular endothelial cells was recently reported. Morisawa et al showed [ 6 ] that NO production increased after 5-ALA administration in a concentration-dependent manner. They suggested that 5-ALA may lower blood pressure by increasing the NO production.…”

Section: Discussionmentioning

confidence: 99%

“…The mechanism of hypotension has been reported in several ways [ 5 ]. Recently, the production of nitric oxide (NO) in vascular endothelial cells has been suggested as a possible mechanism of hypotension [ 6 ]. If NO production is a key mediator of 5-ALA-induced hypotension, arginine vasopressin (AVP) could be an effective treatment for 5-ALA-induced intraoperative hypotension although we know of no reports of this mechanism.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Arginine Vasopressin on Intraoperative Hypotension Caused by Oral Administration of 5-Aminolevulinic Acid

Owada,

Nishizawa,

Matoyama

et al. 2023

Case Reports in Anesthesiology

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5-Aminolevulinic acid (5-ALA) is used for the photodynamic diagnosis of malignant tumors and has been effectively utilized to improve the complete resection rate and reduce the risk of tumor recurrence. However, intraoperative hypotension is a common adverse effect of oral 5-ALA, and it occasionally progresses to severe prolonged hypotension requiring high-dose catecholamine administration. We report a case of intraoperative hypotension due to oral 5-ALA in which arginine vasopressin (AVP) administration was effective for increasing the blood pressure. A 77-year-old man scheduled for a craniotomy for glioma was administered 5-ALA orally before surgery. After the induction of anesthesia, his blood pressure decreased substantially. Although we administered various vasopressor agents, hypotension was prolonged. However, after starting a continuous administration of AVP, the systolic blood pressure increased, and the hemodynamic parameters remained stable during the remainder of the operation. 5-ALA administration may lower blood pressure by inducing nitric oxide production, and AVP inhibits inducible nitric oxide synthase messenger RNA expression and interleukin-1β-stimulated nitric oxide production. In light of these mechanisms, AVP may be a reasonable treatment agent for hypotension induced by 5-ALA.

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“…[47,54,57,58] The 5-ALA application in a series of 12 patients with low-grade glioma showed that fluorescence emissions are very often below the detection threshold of current visual fluorescence imaging methods. [59] 5-aminolevulinic acid-guided microscopic surgery has proven to be an effective way to boost the resection rate in high-grade glioma cells and improve progression-free survival by 6 months, with no decline in performance status compared with conventional surgery. [1,58] Recently, a prospective and multicenter study enrolling 69 high-grade glioma patients taking 5-ALA showed complete resection of enhanced tumors in 51.9% of patients, with a positive predictive value of 95.4% for high-grade glioma histopathology and diagnostic accuracy of 92.4%.…”

Section: Fluoresceinmentioning

confidence: 99%

5-aminolevulinic enhanced brain lesions mimic glioblastoma: A case report and literature review

Chang,

Chen

2024

Medicine

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Rationale: Glioblastoma multiforme (GBM) is a highly malignant primary brain tumor for which maximal tumor resection plays an important role in the treatment strategy. 5-aminolevulinic (5-ALA) is a powerful tool in fluorescence-guided surgery for GBM. However, 5-ALA- enhancing lesion can also be observed with different etiologies. Patients concerns: Three cases of 5-ALA-enhancing lesions with etiologies different from glioma Diagnoses: The final diagnosis was abscess in 1 patient and diffuse large B-cell in the other 2 patients. Interventions: Three patients received 5-aminolevulinic acid-guided tumor resection under microscope with intraoperative neuromonitoring. Outcomes: All of our patients showed improvement or stable neurological function outcomes. The final pathology revealed etiologies different from GBM. Lessons: The 5-aminolevulinic acid fluorescence-guided surgery has demonstrated its maximal extent of resection and safety profile in patients with high-grade glioma. Non-glioma etiologies may also mimic GBM in 5-ALA-guided surgeries. Therefore, patient history taking and consideration of brain images are necessary for the interpretation of 5-ALA-enhanced lesions.

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Association of 5-aminolevulinic acid with intraoperative hypotension in malignant glioma surgery

Cited by 9 publications

References 52 publications

Incidence and predictors of intraoperative hypotension during transurethral bladder tumor resection with oral 5‐aminolevulinic acid

Incidence and predictors of intraoperative hypotension during transurethral bladder tumor resection with oral 5‐aminolevulinic acid

Effect of Arginine Vasopressin on Intraoperative Hypotension Caused by Oral Administration of 5-Aminolevulinic Acid

5-aminolevulinic enhanced brain lesions mimic glioblastoma: A case report and literature review

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