Objective
To determine whether, despite pharmacologic adrenergic receptor blockade, higher preoperative
levels of catecholamines and metanephrines (adrenergic activity) are associated with increased intraoperative complications.
Materials and Methods
Records of patients undergoing paraganglioma and pheochromocytoma (PGL-PCC) resection
from January 1, 2000, to June 30, 2015, were reviewed for preoperative levels of adrenergic
activity, intraoperative variability in blood pressure and heart rate (range), and
postoperative outcomes (hypotension requiring treatment). Patients were categorized
by maximum preoperative adrenergic activity by greater degree of abnormality, categorized
as normal (≤100%) or 101%-200%, 201%-500%, 501%-1000%, and ≥1001% of upper limit of
normal.
Results
In total, 258 patients underwent intrathoracic or intra-abdominal PGL-PCC resection,
of whom 240 received pretreatment with nonselective α1,2-blockers and 7 received pretreatment with selective α1-blockers. Intraoperative hemodynamic variability was greater with higher preoperative
levels of adrenergic activity (P <.001). However, substantial variability was observed even with adrenergic activity
levels within the normal range: systolic blood pressure (median [interquartile range],
75 [63-83] mm Hg) and heart rate (34 [26-43] beats per minute). Among patients with
preoperative levels of adrenergic activity ≤500% vs ≥501% of the upper limit of normal,
higher levels were associated with greater likelihood of postoperative diagnosis of
volume overload (8% vs 2%, P = .04) and greater requirement for vasopressor infusions for hypotension (5% vs 1%,
P = .01).
Conclusion
Substantial intraoperative hemodynamic instability was encountered in patients with
PGL-PCC resection, regardless of preoperative hormonal activity level; therefore,
universal preoperative adrenergic receptor blockade should be recommended. Postoperative
hypotension was rare and more prevalent in those with higher preoperative hormonal
activity.
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Article info
Publication history
Published online: October 18, 2016
Accepted:
October 10,
2016
Received:
August 11,
2016
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Funding Support: Support was provided by the Department of Anesthesiology, Mayo Clinic, Rochester, MN.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
