Skip to main content

Advertisement

SpringerLink
Log in

Incidence of perioperative hypotension in patients undergoing transurethral resection of bladder tumor after oral 5-aminolevulinic acid administration: a retrospective multicenter cohort study

  • Original Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Purpose

Tumors can be visualized using 5-Aminolevulinic acid hydrochloride (5-ALA) during transurethral resection of bladder tumors (TURBT). Hypotension is an adverse effect of 5-ALA; however, its incidence and morbidity rates are unknown. This study aimed to describe the incidence of perioperative hypotension and identify risk factors for hypotension among patients after 5-ALA administration in TURBT.

Methods

This retrospective multicenter cohort study was conducted at three general hospitals in Japan. Adult patients who underwent elective TURBT after 5-ALA administration between April 2018 and August 2020 were included. The primary outcome was the incidence of perioperative hypotension (mean blood pressure < 65 mmHg). The secondary outcomes were the use of vasoactive agents and adverse events, including urgent intensive care unit (ICU) admission. Multivariate logistic regression analysis was performed to investigate risk factors of the incidence of intraoperative hypotension.

Results

The median age of 261 patients was 73 years. General anesthesia was induced in 252 patients. The intraoperative hypotension was observed in 246 (94.3%) patients. Three patients (1.1%) were urgently admitted to the ICU for continued vasoactive agent use after surgery. All three patients had renal dysfunction. Multivariate logistic regression analysis revealed that general anesthesia was significantly associated with intraoperative hypotension (adjusted odds ratio, 17.94; 95% confidence interval, 3.21–100.81).

Conclusion

The incidence of hypotension in patients undergoing TURBT after 5-ALA administration was 94.3%. The incidence of urgent ICU admission with prolonged hypotension was 1.1% in all patients with renal dysfunction. General anesthesia was significantly associated with intraoperative hypotension.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Inoue K, Anai S, Fujimoto K, Hirao Y, Furuse H, Kai F, Ozono S, Hara T, Matsuyama H, Oyama M, Ueno M, Fukuhara H, Narukawa M, Shuin T. Oral 5-aminolevulinic acid mediated photodynamic diagnosis using fluorescence cystoscopy for non-muscle-invasive bladder cancer: a randomized, double-blind, multicentre phase II/III study. Photodiagnosis Photodyn Ther. 2015;12:193–200. https://doi.org/10.1016/j.pdpdt.2015.03.008.

    Article  CAS  PubMed  Google Scholar 

  2. Nakai Y, Inoue K, Tsuzuki T, Shimamoto T, Shuin T, Nagao K, Matsuyama H, Oyama M, Furuse H, Ozono S, Miyake M, Fujimoto K. Oral 5-aminolevulinic acid-mediated photodynamic diagnosis using fluorescence cystoscopy for non-muscle-invasive bladder cancer: a multicenter phase III study. Int J Urol. 2018;25:723–9. https://doi.org/10.1111/iju.13718.

    Article  CAS  PubMed  Google Scholar 

  3. Kida T, Kobashi T, Usuda Y, Kobayashi K, Sumitomo M. Severe and prolonged hypotension after oral 5-aminolevulinic acid administration in a patient with end-stage renal disease undergoing transurethral resection of a bladder tumor: a case report. A A Pract. 2020;14:12–4. https://doi.org/10.1213/xaa.0000000000001128.

    Article  PubMed  Google Scholar 

  4. Shiratori T, Hotta K, Satoh M, Kiuchi C, Ogawa N, Kamigaito T. Preanesthetic severe postural hypotension following 5-aminolevulinic acid pretreatment in patients for photodynamic diagnosis-assisted urological surgery. JA Clin Rep. 2019;5:74. https://doi.org/10.1186/s40981-019-0295-1.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Yatabe T, Marie SL, Fukuhara H, Karashima T, Inoue K, Yokoyama M. 5-Aminolevulinic acid-induced severe hypotension during transurethral resection of a bladder tumor: a case report. JA Clin Rep. 2019;5:58. https://doi.org/10.1186/s40981-019-0279-1.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chung IW, Eljamel S. Risk factors for developing oral 5-aminolevulinic acid-induced side effects in patients undergoing fluorescence guided resection. Photodiagnosis Photodyn Ther. 2013;10:362–7. https://doi.org/10.1016/j.pdpdt.2013.03.007.

    Article  CAS  PubMed  Google Scholar 

  7. Yatabe T, Karashima T, Kume M, Kawanishi Y, Fukuhara H, Ueba T, Inoue K, Okuhara Y, Yokoyama M. Identification of risk factors for post-induction hypotension in patients receiving 5-aminolevulinic acid: a single-center retrospective study. JA Clin Rep. 2020;6:35. https://doi.org/10.1186/s40981-020-00340-9.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Sessler DI, Bloomstone JA, Aronson S, Berry C, Gan TJ, Kellum JA, Plumb J, Mythen MG, Grocott MPW, Edwards MR, Miller TE. Perioperative quality initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery. Br J Anaesth. 2019;122:563–74. https://doi.org/10.1016/j.bja.2019.01.013.

    Article  PubMed  Google Scholar 

  9. Kidney Disease: Improving Outcomes (KDIGO) CKD Work Group. KDIGO. Clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2012;2013(3):1–150. https://doi.org/10.1038/kisup.2012.64.

    Article  Google Scholar 

  10. Nohara T, Kato Y, Nakano T, Nakagawa T, Iwamoto H, Yaegashi H, Nakashima K, Iijima M, Kawaguchi S, Shigehara K, Izumi K, Kadono Y, Mizokami A. Intraoperative hypotension caused by oral administration of 5-aminolevulinic acid for photodynamic diagnosis in patients with bladder cancer. Int J Urol. 2019;26:1064–8. https://doi.org/10.1111/iju.14099.

    Article  CAS  PubMed  Google Scholar 

  11. Fukuhara H, Nohara T, Nishimoto K, Hatakeyama Y, Hyodo Y, Okuhara Y, Oyama M, Mizokami A, Inoue K, Matsuyama H. Japan Urological Photodynamic Society Identification of risk factors associated with oral 5-aminolevulinic acid-induced hypotension in photodynamic diagnosis for non-muscle invasive bladder cancer: a multicenter retrospective study. BMC Cancer. 2021;21:1223. https://doi.org/10.1186/s12885-021-08976-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Mingone CJ, Gupte SA, Chow JL, Ahmad M, Abraham NG, Wolin MS. Protoporphyrin IX generation from delta-aminolevulinic acid elicits pulmonary artery relaxation and soluble guanylate cyclase activation. Am J Physiol Lung Cell Mol Physiol. 2006;291:L337–44. https://doi.org/10.1152/ajplung.00482.2005.

    Article  CAS  PubMed  Google Scholar 

  13. Eichhorn V, Maerz A, Salomon G, Blanc IF, Reuter DA, Goetz AE. Hemodynamic effects of orally administered delta-ALA during radical prostatectomy. World J Urol. 2013;31:371–6. https://doi.org/10.1007/s00345-011-0788-7.

    Article  CAS  PubMed  Google Scholar 

  14. Sato M, Yanagisawa T, Minamino S, Arai T. Hypotension caused by oral administration of 5-aminolevulinic acid persists after surgery in patients undergoing transurethral resection of bladder tumor under spinal anesthesia. JA Clin Rep. 2020;6:93. https://doi.org/10.1186/s40981-020-00399-4.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Miyakawa J, Kawai T, Makino K, Akiyama Y, Yamada Y, Nakamura M, Sato Y, Yamada D, Suzuki M, Kume H. Impact of age, body mass index, and renal function for severe hypotension caused by oral 5-aminolevulinic acid administration in patients undergoing transurethral resection of bladder tumor. Photodiagnosis Photodyn Ther. 2021;33:102179. https://doi.org/10.1016/j.pdpdt.2021.102179.

    Article  CAS  PubMed  Google Scholar 

  16. Dalton JT, Yates CR, Yin D, Straughn A, Marcus SL, Golub AL, Meyer MC. Clinical pharmacokinetics of 5-aminolevulinic acid in healthy volunteers and patients at high risk for recurrent bladder cancer. J Pharmacol Exp Ther. 2002;301:507–12. https://doi.org/10.1124/jpet.301.2.507.

    Article  CAS  PubMed  Google Scholar 

  17. Gorchein A, Webber R. delta-Aminolaevulinic acid in plasma, cerebrospinal fluid, saliva and erythrocytes: studies in normal, uraemic and porphyric subjects. Clin Sci (Lond). 1987;72:103–12. https://doi.org/10.1042/cs0720103.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

The study did not receive funding from any company or organization.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Yokohama Rosai Hospital, 3211 Kodukuecho, Kouhoku-Ku, Yokohama, Kanagawa, 222-0036, Japan

    Yuriko Kondo, Nanako Yoshikawa & Noriyuki Echigo

  2. Department of Anesthesiology and Critical Care Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan

    Yusuke Nagamine & Takahisa Goto

  3. Department of Anesthesiology, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Dori, Yokosuka, Kanagawa, 238-8558, Japan

    Tatsuya Kida & Masakazu Sumitomo

  4. Department of Anesthesiology, Yokohama Municipal Citizen’s Hospital, 1-1 Mitsuzawa Nishimachi, Kanagawa-Ku, Yokohama, Kanagawa, 221-0855, Japan

    Megumi Yoshida & Gaku Inagawa

Authors
  1. Yuriko Kondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yusuke Nagamine
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nanako Yoshikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Noriyuki Echigo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tatsuya Kida
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masakazu Sumitomo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Megumi Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gaku Inagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Takahisa Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: YK, YN. Investigation: YK, NY, TK, MY. Methodology: YK, YN. Project administration: YK, NE, TK, MS, MY, GI. Supervision: YN, TG. Visualization: YK. Writing–original draft: YK. Writing–review and editing: YN, NY, NE, TK, MS, MY, GI, TG. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yusuke Nagamine.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This study was approved by the ethics committee of the Yokohama Rosai Hospital, the core institution (approval number: 2–26; chairperson: Dr. Youji Mikami; approval date: August 24, 2020), and by the ethics committees of the participating institutions (Yokohama Municipal Citizen’s Hospital [approval number: 20–10-02; chairperson: Dr. Akihiro Nakazawa; approval date: October 14, 2020] and Yokosuka Kyosai Hospital [approval number: 20–57; chairperson: Dr. Takashi Irioka; approval date: September 29, 2020]). The requirement of informed consent was waived by the ethics committees (Yokohama Rosai Hospital, Yokohama Municipal Citizen’s Hospital, and Yokosuka Kyosai Hospital). The opportunity to withdraw consent was indicated by a notice on the website of each facility. All methods were carried out in accordance with the Declaration of Helsinki.

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 28 KB)

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kondo, Y., Nagamine, Y., Yoshikawa, N. et al. Incidence of perioperative hypotension in patients undergoing transurethral resection of bladder tumor after oral 5-aminolevulinic acid administration: a retrospective multicenter cohort study. J Anesth 37, 703–713 (2023). https://doi.org/10.1007/s00540-023-03222-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-023-03222-3

Keywords

Search

Navigation