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World Journal of Urology

, Volume 31, Issue 2, pp 371–376 | Cite as

Hemodynamic effects of orally administered delta-ALA during radical prostatectomy

  • Volker EichhornEmail author
  • Alexander Maerz
  • Georg Salomon
  • Irmgard F. Blanc
  • Daniel A. Reuter
  • Alwin E. Goetz
Original Article

Abstract

Purpose

We investigated hemodynamics in patients receiving delta-Aminolevulinic acid (delta-ALA) to visualize tumor margins prior to radical retro pubic prostatectomy.

Patients

Twenty patients undergoing elective open radical retro pubic prostatectomy (RRP).

Methods

Cohort observational study. Ten patients receiving 20 mg/kg of delta-ALA orally prior to surgery (delta-ALA) and 10 patients undergoing RRP without the application of delta-ALA served as a retrospectively matched cohort (CONTROL).

Measurements

Changes in heart rate (HR), mean arterial blood pressure (MAP), and functional hemodynamic parameters were assessed by electrocardiogram, non-invasive and invasive blood pressure monitoring plus transcardiopulmonary thermodilution.

Results

Patients of both groups did not differ in means of age, body mass index, or ASA classification. During surgery, HR and MAP did not differ significantly between both groups. Also, the amount of IV crystalloids and colloids did not differ significantly. In contrast, the amount of vasopressor necessary to maintain MAP within the target range of 70–90 mmHg was significantly higher in delta-ALA when compared to CONTROL (0.08 ± 0.04 μg/kg/min (delta-ALA) vs. 0.03 ± 0.02 μg/kg/min (CONTROL); P < 0.01). Immediately after surgery, patients of delta-ALA showed a significantly higher heart rate (82 ± 18 min−1 vs. 67 ± 9 min−1; P < 0.05) compared to patients of CONTROL. Cardiac index, global end-diastolic volume index, and extravascular lung water index were significantly higher after surgery, when compared to baseline values (P < 0.05).

Conclusions

Orally administered delta-ALA prior to open radical prostatectomy induces hemodynamic instability in the perioperative period requiring vasopressor support. Further, an increase of extravascular lung water points toward an increased vascular permeability induced by delta-ALA.

Keywords

delta-Aminolevulinic acid Hemodynamics Vascular tone Preload Transcardiopulmonary thermodilution Extravascular lung water 

Notes

Conflict of interest

All possible conflicts of interest are hereby disclosed from all authors.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Volker Eichhorn
    • 1
    Email author
  • Alexander Maerz
    • 1
  • Georg Salomon
    • 2
  • Irmgard F. Blanc
    • 1
  • Daniel A. Reuter
    • 1
  • Alwin E. Goetz
    • 1
  1. 1.Department of Anesthesiology, Center of Anesthesiology and Intensive Care MedicineUniversity Medical Center Hamburg-Eppendorf, Hamburg Eppendorf University HospitalHamburgGermany
  2. 2.Martiniklinik—Prostate Cancer Center Hamburg EppendorfHamburgGermany

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