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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2020

Open Access 01-12-2020 | Hypotension | Research article

Preoperative intravenous rehydration for patients with pheochromocytomas and paragangliomas: is it necessary? A propensity score matching analysis

Authors: Hao Kong, Jiao-Nan Yang, Jie Tian, Nan Li, Yu-Xiu Zhang, Peng-Cheng Ye, Xue-Ying Li, Zheng Zhang

Published in: BMC Anesthesiology | Issue 1/2020

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Abstract

Background

Preoperative intravenous rehydration for patients with pheochromocytomas and paragangliomas (PPGLs) is widely used in many medical centers, but its usefulness has not been well evaluated. The objective of this study was to compare the perioperative hemodynamics and early outcome between patients who received preoperative intravenous rehydration and those without for resection of PPGLs.

Methods

In this retrospective propensity score-matched cohort study, the data of patients who underwent surgery for PPGLs were collected. Patients were divided into two groups depending on whether they received or did not receive intravenous rehydration preoperatively. The primary endpoint was intraoperative hypotension, described as the cumulative time of mean arterial pressure < 65 mmHg averaged by surgery duration.

Results

Among 231 enrolled patients, 113 patients received intravenous rehydration of ≥2000 ml daily for ≥2 days before surgery and 118 patients who did not have any intravenous rehydration before surgery. After propensity score matching, 85 patients remained in each group. The median cumulative time of mean arterial pressure < 65 mmHg averaged by surgery duration was not significantly different between rehydrated patients and non-rehydrated patients (median 3.0% [interquartile range 0.2–12.2] versus 3.8% [0.0–14.2], median difference 0.0, 95%CI − 1.2 to 0.8, p = 0.909). The total dose of catecholamines given intraoperatively, volume of intraoperative fluids, intraoperative tachycardia and hypertension, percentage of patients who suffered from postoperative hypotension, postoperative diuretics use, and postoperative early outcome between the two groups were not significantly different either.

Conclusions

For patients with PPGLs, preoperative intravenous rehydration failed to optimize perioperative hemodynamics or improve early outcome.
Appendix
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Literature
1.
Naranjo J, Dodd S, Martin YN. Perioperative Management of Pheochromocytoma. J Cardiothorac Vasc Anesth. 2017;31:1427–39.PubMedCrossRef
2.
Lenders JW, Duh QY, Eisenhofer G, et al. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99:1915–42.PubMedCrossRef
3.
Challis BG, Casey RT, Simpson HL, Gurnell M. Is there an optimal preoperative management strategy for phaeochromocytoma/paraganglioma? Clin Endocrinol. 2017;86:163–7.CrossRef
4.
Whitelaw BC, Prague JK, Mustafa OG, et al. Phaeochromocytoma crisis. Clin Endocrinol. 2014;80:13–22.CrossRef
5.
Chen H, Sippel RS, O'Dorisio MS, et al. The north American neuroendocrine tumor society consensus guideline for the diagnosis and management of neuroendocrine tumors: pheochromocytoma, paraganglioma, and medullary thyroid cancer. Pancreas. 2010;39:775–83.PubMedPubMedCentralCrossRef
6.
Hack HA. The perioperative management of children with phaeochromocytoma. Paediatr Anaesth. 2000;10:463–76.PubMedCrossRef
7.
8.
Bai S, Wu B, Yao Z, Zhu X, Jiang Y, Wang H. Development and validation of a clinical model to predict intraoperative hemodynamic instability in patients with pheochromocytomas surgery. Endocr J. 2020;67:81–9.PubMedCrossRef
9.
Lentschener C, Gaujoux S, Tesniere A, Dousset B. Point of controversy: perioperative care of patients undergoing pheochromocytoma removal-time for a reappraisal? Eur J Endocrinol. 2011;165:365–73.PubMedCrossRef
10.
Lentschener C, Gaujoux S, Baillard C, Dousset B. Inappropriate adrenoreceptor blockade prior to phaeochromocytoma removal is perhaps a 'timely reappraisal'? Clin Endocrinol. 2016;85:989–90.CrossRef
11.
Schimmack S, Kaiser J, Probst P, Kalkum E, Diener MK, Strobel O. Meta-analysis of α-blockade versus no blockade before adrenalectomy for phaeochromocytoma. Br J Surg. 2020;107:e102–8.PubMedCrossRef
12.
Groeben H, Walz MK, Nottebaum BJ, et al. International multicentre review of perioperative management and outcome for catecholamine-producing tumours. Br J Surg. 2020;107:e170–8.PubMedCrossRefPubMedCentral
13.
Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators, Spence J, LeManach Y, et al. Association between complications and death within 30 days after noncardiac surgery. CMAJ. 2019;191:E830–7.CrossRef
14.
Turan A, Mascha EJ, You J, et al. The association between nitrous oxide and postoperative mortality and morbidity after noncardiac surgery. Anesth Analg. 2013;116:1026–33.PubMedCrossRef
15.
Niederle MB, Fleischmann E, Kabon B, Niederle B. The determination of real fluid requirements in laparoscopic resection of pheochromocytoma using minimally invasive hemodynamic monitoring: a prospectively designed trial. Surg Endosc. 2020;34:368–76.PubMedCrossRef
16.
17.
Nakahira J, Sawai T, Minami T. Elective use of intra-aortic balloon pump during aortic valve replacement in elderly patients to reduce postoperative cardiac complications. Artif Organs. 2014;38:503–7.PubMedCrossRef
18.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.PubMedCrossRef
19.
Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009;28:3083–107.PubMedPubMedCentralCrossRef
20.
21.
Desmonts JM, Marty J. Anaesthetic management of patients with phaeochromocytoma. Br J Anaesth. 1984;56:781–9.PubMedCrossRef
22.
Gunawardane PTK, Grossman A. Phaeochromocytoma and Paraganglioma. Adv Exp Med Biol. 2017;956:239–59.PubMedCrossRef
23.
Buitenwerf E, Osinga TE, Timmers HJLM, et al. Efficacy of α-Blockers on Hemodynamic Control during Pheochromocytoma Resection: A Randomized Controlled Trial. J Clin Endocrinol Metab. 2020;105:dgz188.PubMedCrossRef
24.
Yanbo W, Xiaobo D, Yuchuan H, et al. Retroperitoneal laparoscopy rather than an open procedure for resection of pheochromocytomas could minimize intraoperative blood pressure fluctuations and transfusion events. Int Urol Nephrol. 2011;43:353–7.PubMedCrossRef
25.
Wu G, Zhang B, Yu C, et al. Effect of early adrenal vein ligation on blood pressure and catecholeamine fluctuation during laparoscopic adrenalectomy for pheochromocytoma. Urology. 2013;82:606–11.PubMedCrossRef
26.
Bruynzeel H, Feelders RA, Groenland TH, et al. Risk factors for hemodynamic instability during surgery for Pheochromocytoma. J Clin Endocrinol Metab. 2010;95:678–85.PubMedCrossRef
27.
Namekawa T, Utsumi T, Kawamura K, et al. Clinical predictors of prolonged postresection hypotension after laparoscopic adrenalectomy for pheochromocytoma. Surgery. 2016;159:763–70.PubMedCrossRef
28.
Chang RY, Lang BH, Wong KP, Lo CY. High pre-operative urinary norepinephrine is an independent determinant of peri-operative hemodynamic instability in unilateral pheochromocytoma/paraganglioma removal. World J Surg. 2014;38:2317–23.PubMedCrossRef
29.
Bai S, Yao Z, Zhu X, et al. Comparison of transperitoneal laparoscopic versus open adrenalectomy for large pheochromocytoma: a retrospective propensity score-matched cohort study. Int J Surg. 2019;61:26–32.PubMedCrossRef
30.
McKinley MJ, Johnson AK. The physiological regulation of thirst and fluid intake. News Physiol Sci. 2004;19:1–6.PubMed
31.
Westphal M, James MF, Kozek-Langenecker S, Stocker R, Guidet B, Van Aken H. Hydroxyethyl starches: different products--different effects. Anesthesiology. 2009;111:187–202.PubMedCrossRef
32.
Sjoerdsma A, Engelman K, Waldmann TA, Cooperman LH, Hammond WG. Pheochromocytoma: current concepts of diagnosis and treatment: combined clinical staff conference at the National Institutes of Health. Ann Intern Med. 1966;65:1302–26.CrossRef
33.
Lentschener C, Gaujoux S, Thillois JM, et al. Increased arterial pressure is not predictive of haemodynamic instability in patients undergoing adrenalectomy for phaeochromocytoma. Acta Anaesthesiol Scand. 2009;53:522–7.PubMedCrossRef
34.
Mallat J, Pironkov A, Destandau MS, Tavernier B. Systolic pressure variation (Deltadown) can guide fluid therapy during pheochromocytoma surgery. Can J Anaesth. 2003;50:998–1003.PubMedCrossRef
35.
Iijima T, Takagi T, Iwao Y. An increased circulating blood volume does not prevent hypotension after pheochromocytoma resection. Can J Anaesth. 2004;51:212–5.PubMedCrossRef
36.
37.
Ross EJ, Prichard BNC, Kaufman L, Robertson AI, Harries BJ. Preoperative and operative management of patients with pheochromocytoma. BMJ. 1967;1:191–8.PubMedCrossRefPubMedCentral
38.
Groeben H, Nottebaum BJ, Alesina PF, Traut A, Neumann HP, Walz MK. Perioperative α-receptor blockade in phaeochromocytoma surgery: an observational case series. Br J Anaesth. 2017;118:182–9.PubMedCrossRef
39.
40.
Pisarska M, Pędziwiatr M, Budzyński A. Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma. Gland Surg. 2016;5:506–11.PubMedPubMedCentralCrossRef
41.
Isosu T, Obara S, Ohashi S, et al. Examination of the usefulness of non-invasive stroke volume variation monitoring for adjusting fluid supplementation during laparoscopic adrenalectomy in patients with pheochromocytoma. Fukushima J Med Sci. 2012;58:78–81.PubMedCrossRef
42.
Lenders JW, Pacak K, Walther MM, et al. Biochemical diagnosis of pheochromocytoma: which test is best? JAMA. 2002;287:1427–34.PubMedCrossRef
43.
Al-Harthy M, Al-Harthy S, Al-Otieschan A, Velagapudi S, Alzahrani AS. Comparison of pheochromocytomas and abdominal and pelvic paragangliomas with head and neck paragangliomas. Endocr Pract. 2009;15:194–202.PubMedCrossRef
Metadata
Title
Preoperative intravenous rehydration for patients with pheochromocytomas and paragangliomas: is it necessary? A propensity score matching analysis
Authors
Hao Kong
Jiao-Nan Yang
Jie Tian
Nan Li
Yu-Xiu Zhang
Peng-Cheng Ye
Xue-Ying Li
Zheng Zhang
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2020
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-020-01212-6

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