Identification of risk factors for post-induction hypotension in patients receiving 5-aminolevulinic acid: a single-center retrospective study

Abstract

Background 5-Aminolevulinic acid (5-ALA) is useful as a photodynamic agent, but its use commonly leads to hypotension. Although avoiding a mean arterial pressure (MAP) < 60 mmHg is important, the incidence of MAP < 60 mmHg when using 5-ALA is unclear. Therefore, we conducted a retrospective study to assess the incidence of post-induction hypotension and identified risk factors of this phenomenon. Methods One-hundred and seventy-two consecutive patients who underwent transurethral resection of the bladder tumor or craniotomy with the use of 5-ALA were enrolled. The primary outcome was the incidence of post-induction hypotension, defined as MAP < 60 mmHg during the first 1 h after anesthesia induction. We divided participants into the normal blood pressure group (group N) and the hypotension group (group L). Results The incidence of post-induction hypotension was 70% (group L = 121, group N = 51). Multivariate analysis revealed that female sex was an independent factor of post-induction hypotension (odds ratio [OR] 3.95; 95% confidence interval [CI] 1.21–12.97; p = 0.02). Systolic blood pressure < 100 mmHg before anesthesia induction and general anesthesia were also identified as significant independent factors (OR 13.30; 95% CI 1.17–151.0; p = 0.04 and OR 25.84; 95% CI 9.80–68.49; p < 0.001, respectively). Conclusions The incidence of post-induction hypotension was 70% in patients using 5-ALA. Female sex, systolic blood pressure < 100 mmHg before anesthesia induction, and general anesthesia might be independent factors of post-induction hypotension when using 5-ALA.

Differences in 5-Aminolevulinic Acid-Induced Hemodynamic Changes between Patients Undergoing Neurosurgery and Urological Surgery

“…The correlation between intraoperative hypotension (SBP <80mmHg) and the use of antihypertensives was deemed significant (P = 0.015). Although general anesthesia may be a risk factor for 5-ALA-induced intraoperative hypotension (16) , (17) , the relation between intraoperative hypotension and anesthesia method was not significant in this study (P = 0.075).…”

“…The method of anesthesia in urological surgery was significantly different between the 5-ALA-pretreated and non-pretreated patients. As previously reported, general anesthesia may be associated with 5-ALA-induced hypotension (16) , (17) . Thus, the method of anesthesia was added as an IPW variable in the urological surgery patients.…”

“…In severe cases, 5-ALA-induced hemodynamic changes occurred preoperatively and postoperatively persisted (12) , (13) , (14) . Reportedly, the real-world incidence of 5-ALA-induced hypotension was high in patients who underwent PDD-assisted urological surgery (15) , (16) , (17) , (18) , (19) . However, the cause of 5-ALA-induced hypotension remains unknown.…”

Hypotension caused by oral administration of 5-aminolevulinic acid persists after surgery in patients undergoing transurethral resection of bladder tumor under spinal anesthesia

“…To the Editor, 5-Aminolevulinic acid (ALA) is utilized for photodynamic diagnosis to detect superficial bladder cancer and its adverse effect is hypotension [1][2][3][4][5]. Compared to general anesthesia, spinal anesthesia is not indicated as an increased risk factor for 5-ALA-induced hypotension from anesthesia induction to the start of surgery in patients undergoing transurethral resection of bladder tumor (TUR-BT) with 5-ALA [2,3]. However, no studies exist that have investigated the precise perioperative hypotensive effects by 5-ALA under spinal anesthesia.…”

Identification of risk factors associated with oral 5-aminolevulinic acid-induced hypotension in photodynamic diagnosis for non-muscle invasive bladder cancer: a multicenter retrospective study

“…Previous studies have reported the incidence of ALA-induced hypotension as 2–3% [ 9 , 10 ]. Cases of severe hypotension requiring intensive care management after using ALAGRIO® have been reported in Japan [ 11 – 13 ].…”