Takeshi Namekawa1, Takanobu Utsumi2, Koji Kawamura1, Naoto Kamiya3, Takashi Imamoto1, Tomoko Takiguchi4, Naoko Hashimoto4, Tomoaki Tanaka4, Yukio Naya5, Hiroyoshi Suzuki3, Tomohiko Ichikawa1. 1. Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan. 2. Department of Urology, Toho University Sakura Medical Center, Chiba, Japan. Electronic address: takanobu.utsumi@med.toho-u.ac.jp. 3. Department of Urology, Toho University Sakura Medical Center, Chiba, Japan. 4. Department of Clinical Cell Biology, Graduate School of Medicine, Chiba University, Chiba, Japan. 5. Department of Urology, Teikyo University Chiba Medical Center, Chiba, Japan.
Abstract
BACKGROUND: Although the perioperative management of patients with pheochromocytoma has been improving recently, severe hypotensive episodes can occur that require postoperative catecholamine support and are challenging to manage. Our aim was to identify the clinical factors that predict prolonged postresection hypotension in patients after laparoscopic adrenalectomy for pheochromocytoma. METHODS: The records of 73 Japanese patients who underwent unilateral laparoscopic adrenalectomy for pheochromocytoma were surveyed retrospectively. Patients were divided into 2 groups according to whether catecholamine support was needed after postoperatively. Clinical and biochemical data were evaluated at baseline and after operation. RESULTS: Thirty-four of 73 patients (47%) required continuous infusion of catecholamine to maintain systolic blood pressure >90 mm Hg at the end of the operation. The median duration of postoperative catecholamine support was 17 hours (range, 3-130) in these 34 patients. On multivariate analysis, tumor size >60 mm, urinary epinephrine levels >200 μg/day, and urinary norepinephrine levels >600 μg/day were independent predictors of prolonged hypotension requiring postoperative catecholamine support. Tumor size and urinary norepinephrine levels were significantly correlated with the duration of postoperative catecholamine support. CONCLUSION: Larger tumor size and greater values of urinary epinephrine and norepinephrine levels were significant predictors of prolonged hypotension requiring postoperative catecholamine support. Moreover, tumor size and urinary norepinephrine levels were positively correlated with the duration of postoperative catecholamine support. Clinicians can identify and manage patients more effectively with a greater risk of prolonged hypotension after tumor resection using these preoperative clinical variables.
BACKGROUND: Although the perioperative management of patients with pheochromocytoma has been improving recently, severe hypotensive episodes can occur that require postoperative catecholamine support and are challenging to manage. Our aim was to identify the clinical factors that predict prolonged postresection hypotension in patients after laparoscopic adrenalectomy for pheochromocytoma. METHODS: The records of 73 Japanese patients who underwent unilateral laparoscopic adrenalectomy for pheochromocytoma were surveyed retrospectively. Patients were divided into 2 groups according to whether catecholamine support was needed after postoperatively. Clinical and biochemical data were evaluated at baseline and after operation. RESULTS: Thirty-four of 73 patients (47%) required continuous infusion of catecholamine to maintain systolic blood pressure >90 mm Hg at the end of the operation. The median duration of postoperative catecholamine support was 17 hours (range, 3-130) in these 34 patients. On multivariate analysis, tumor size >60 mm, urinary epinephrine levels >200 μg/day, and urinary norepinephrine levels >600 μg/day were independent predictors of prolonged hypotension requiring postoperative catecholamine support. Tumor size and urinary norepinephrine levels were significantly correlated with the duration of postoperative catecholamine support. CONCLUSION: Larger tumor size and greater values of urinary epinephrine and norepinephrine levels were significant predictors of prolonged hypotension requiring postoperative catecholamine support. Moreover, tumor size and urinary norepinephrine levels were positively correlated with the duration of postoperative catecholamine support. Clinicians can identify and manage patients more effectively with a greater risk of prolonged hypotension after tumor resection using these preoperative clinical variables.
Authors: Joseph M Pappachan; Nyo Nyo Tun; Ganesan Arunagirinathan; Ravinder Sodi; Fahmy W F Hanna Journal: Curr Hypertens Rep Date: 2018-01-22 Impact factor: 5.369
Authors: Joseph P Thompson; Davinia Bennett; James Hodson; Miriam Asia; John Ayuk; Michael W O'Reilly; Niki Karavitaki; Wiebke Arlt; Robert P Sutcliffe Journal: Gland Surg Date: 2019-12