Cargando…

Preoperative blood pressure targets and effect on hemodynamics in pheochromocytoma and paraganglioma

Patients with pheochromocytoma and paraganglioma (PPGL) are treated with α-adrenoceptor antagonists to improve peroperative hemodynamics. However, preoperative blood pressure targets differ between institutions. We retrospectively compared per- and postoperative hemodynamics in 30 patients with PPGL...

Descripción completa

Detalles Bibliográficos
Autores principales: Ugleholdt, Randi, Rasmussen, Åse Krogh, Haderslev, Pernille A H, Kromann-Andersen, Bjarne, Feltoft, Claus Larsen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9175583/
https://www.ncbi.nlm.nih.gov/pubmed/35358058
http://dx.doi.org/10.1530/EC-21-0539
_version_ 1784722483540131840
author Ugleholdt, Randi
Rasmussen, Åse Krogh
Haderslev, Pernille A H
Kromann-Andersen, Bjarne
Feltoft, Claus Larsen
author_facet Ugleholdt, Randi
Rasmussen, Åse Krogh
Haderslev, Pernille A H
Kromann-Andersen, Bjarne
Feltoft, Claus Larsen
author_sort Ugleholdt, Randi
collection PubMed
description Patients with pheochromocytoma and paraganglioma (PPGL) are treated with α-adrenoceptor antagonists to improve peroperative hemodynamics. However, preoperative blood pressure targets differ between institutions. We retrospectively compared per- and postoperative hemodynamics in 30 patients with PPGL that were pretreated with phenoxybenzamine aiming at different blood pressure targets at two separate endocrine departments. All patients were subsequently undergoing laparoscopic surgery at Department of Urology, Herlev University hospital. Fourteen patients were treated targeting to symptomatic and significant orthostatic hypotension and 16 patients to a seated blood pressure below 130/80 mmHg. As a control group, we included 34 patients undergoing laparoscopic adrenalectomy for other reasons. The group titrated to orthostatic hypotension required a higher dose of phenoxybenzamine to achieve the blood pressure target. This group had less intraoperative systolic and diastolic blood pressure fluctuation (Mann–Whitney U test; P  < 0.05) and less periods with heart rate above 100 b.p.m. (Mann–Whitney U test; P = 0.04) as compared to the group with a preoperative blood pressure target below 130/80 mmHg. Peroperative use of intravenous fluids were similar between the two groups, but postoperatively more intravenous fluids were administered in the group with a target of ortostatism. Overall, the control group was more hemodynamic stable as compared to either group treated for PPGL. We conclude that phenoxybenzamine pretreatment targeting ortostatic hypotension may improve peroperative hemodynamic stability but causes a higher postoperative requirement for intravenous fluids. Overall, PPGL surgery is related to greater hemodynamic instability compared to adrenalectomy for other reasons.
format Online
Article
Text
id pubmed-9175583
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Bioscientifica Ltd
record_format MEDLINE/PubMed
spelling pubmed-91755832022-06-14 Preoperative blood pressure targets and effect on hemodynamics in pheochromocytoma and paraganglioma Ugleholdt, Randi Rasmussen, Åse Krogh Haderslev, Pernille A H Kromann-Andersen, Bjarne Feltoft, Claus Larsen Endocr Connect Research Patients with pheochromocytoma and paraganglioma (PPGL) are treated with α-adrenoceptor antagonists to improve peroperative hemodynamics. However, preoperative blood pressure targets differ between institutions. We retrospectively compared per- and postoperative hemodynamics in 30 patients with PPGL that were pretreated with phenoxybenzamine aiming at different blood pressure targets at two separate endocrine departments. All patients were subsequently undergoing laparoscopic surgery at Department of Urology, Herlev University hospital. Fourteen patients were treated targeting to symptomatic and significant orthostatic hypotension and 16 patients to a seated blood pressure below 130/80 mmHg. As a control group, we included 34 patients undergoing laparoscopic adrenalectomy for other reasons. The group titrated to orthostatic hypotension required a higher dose of phenoxybenzamine to achieve the blood pressure target. This group had less intraoperative systolic and diastolic blood pressure fluctuation (Mann–Whitney U test; P  < 0.05) and less periods with heart rate above 100 b.p.m. (Mann–Whitney U test; P = 0.04) as compared to the group with a preoperative blood pressure target below 130/80 mmHg. Peroperative use of intravenous fluids were similar between the two groups, but postoperatively more intravenous fluids were administered in the group with a target of ortostatism. Overall, the control group was more hemodynamic stable as compared to either group treated for PPGL. We conclude that phenoxybenzamine pretreatment targeting ortostatic hypotension may improve peroperative hemodynamic stability but causes a higher postoperative requirement for intravenous fluids. Overall, PPGL surgery is related to greater hemodynamic instability compared to adrenalectomy for other reasons. Bioscientifica Ltd 2022-03-31 /pmc/articles/PMC9175583/ /pubmed/35358058 http://dx.doi.org/10.1530/EC-21-0539 Text en © The authors https://creativecommons.org/licenses/by-nc/4.0/This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. (https://creativecommons.org/licenses/by-nc/4.0/)
spellingShingle Research
Ugleholdt, Randi
Rasmussen, Åse Krogh
Haderslev, Pernille A H
Kromann-Andersen, Bjarne
Feltoft, Claus Larsen
Preoperative blood pressure targets and effect on hemodynamics in pheochromocytoma and paraganglioma
title Preoperative blood pressure targets and effect on hemodynamics in pheochromocytoma and paraganglioma
title_full Preoperative blood pressure targets and effect on hemodynamics in pheochromocytoma and paraganglioma
title_fullStr Preoperative blood pressure targets and effect on hemodynamics in pheochromocytoma and paraganglioma
title_full_unstemmed Preoperative blood pressure targets and effect on hemodynamics in pheochromocytoma and paraganglioma
title_short Preoperative blood pressure targets and effect on hemodynamics in pheochromocytoma and paraganglioma
title_sort preoperative blood pressure targets and effect on hemodynamics in pheochromocytoma and paraganglioma
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9175583/
https://www.ncbi.nlm.nih.gov/pubmed/35358058
http://dx.doi.org/10.1530/EC-21-0539
work_keys_str_mv AT ugleholdtrandi preoperativebloodpressuretargetsandeffectonhemodynamicsinpheochromocytomaandparaganglioma
AT rasmussenasekrogh preoperativebloodpressuretargetsandeffectonhemodynamicsinpheochromocytomaandparaganglioma
AT haderslevpernilleah preoperativebloodpressuretargetsandeffectonhemodynamicsinpheochromocytomaandparaganglioma
AT kromannandersenbjarne preoperativebloodpressuretargetsandeffectonhemodynamicsinpheochromocytomaandparaganglioma
AT feltoftclauslarsen preoperativebloodpressuretargetsandeffectonhemodynamicsinpheochromocytomaandparaganglioma