Risk factors for prolonged hypotension in patients with pheochromocytoma undergoing laparoscopic adrenalectomy: a single-center retrospective study

Abstract

Prolonged hypotension during pheochromocytoma resection is a significant complication. We sought to investigate the predictors of prolonged hypotension in patients with pheochromocytoma undergoing laparoscopic adrenalectomy (LA). Patients with pheochromocytoma who underwent LA between 2012 and 2015 were surveyed. Patients were considered to have prolonged hypotension if they had a mean arterial blood pressure <60 mmHg or required ≥30 consecutive minutes of catecholamine support intraoperatively. Among 123 patients, 54 (43.9%) developed prolonged hypotension requiring ≥30 consecutive minutes of catecholamine support. Compared with patients with nonprolonged hypotension, those with prolonged hypotension had higher levels of urinary norepinephrine (P = 0.011), epinephrine (P < 0.001), and dopamine (P = 0.019) preoperatively, and a higher incidence of vital organ injury postoperatively (P = 0.039). Multivariate logistic analysis showed that independent predictors for prolonged hypotension were multiples of the normal reference upper limit value of urinary epinephrine (odds ratio, 1.180; 95% confidence interval, 1.035–1.345) and dopamine (odds ratio, 4.375; 95% confidence interval, 1.207–15.855). The levels of preoperative urinary epinephrine and dopamine are clinical predictors for prolonged hypotension in patients with pheochromocytoma undergoing LA. Using these parameters, clinicians can assess and manage this patient population more effectively.

Internal validation and decision curve analysis of a preoperative nomogram predicting a postoperative complication in pheochromocytoma surgery: An international study

“…17 Conversely, Wu et al found that of 91% of 123 patients who required postoperative catecholamine support experienced preoperative symptoms. 12,16 Tumor size and patient age have previously been reported in unrelated studies as significant predictors of a complication after pheochromocytoma surgery. Kwon et al and Namekawa et al, for example, found that tumor size cut-offs of 4.5 cm and 6 cm, respectively, especially in the setting of elevated urinary epinephrine levels, predicted significant hemodynamic instability.…”

“…[6][7][8] High preoperative blood pressure, tumor size and elevated epinephrine levels have been associated with intraoperative hemodynamic instability and postoperative hypotension. [9][10][11][12] There is currently no standardized method to assess for perioperative risk for PC other than those for any patient undergoing non-cardiac surgery. Our aim was to use a multicenter database of pheochromocytoma patients who underwent adrenalectomy in order to develop a preoperative nomogram that could predict the risk of any POC.…”

Intraoperative modulation of arterial blood flow in a hybrid operating room: A report of three cases

“…Adrenal pheochromocytomas are catecholamine‐producing tumors that may cause perioperative hemodynamic changes, such as hypertension (resulting from anesthesia induction or adrenal gland manipulation) and prolonged hypotension (postresection). These hemodynamic changes have also been reported during IVR treatment alone .…”

Pheochromocytoma Secreting Large Quantities of Both Epinephrine and Norepinephrine Presenting with Episodes of Hypotension and Severe Electrolyte Imbalance

“…The high plasma epinephrine/norepinephrine ratio indicates that the epinephrine production is augmented compared with norepinephrine. Hypotension is explained by the down-regulation of vascular alpha one adrenergic receptors from exposure to a significant amount of epinephrine resulting in the decrease of the peripheral vascular resistance [ 6 - 7 ]. Vomiting may lead to hypokalemia, but hypokalemia recurred after repletion of potassium and cessation of vomiting.…”