Perioperative hypertension in phaeochromocytoma patients undergoing adrenalectomy
This study was designed to compare perioperative blood pressure (BP) management in hypertensive patients with phaeochromocytoma undergoing preoperative α-blockade and in patients with other suprarenal gland tumors. Perioperative hemodynamic data and immediate postoperative outcome in two groups undergoing adrenalectomy were compared. 483 medical charts from urologic patients with tumors were analyzed. In the hypertensive (n = 168) group, 20 patients with suprarenal gland tumors were identified (phaeochromocytoma n = 11, other tumors n = 9). Demographic data, intraoperative consumption of fentanyl and phentolamine, preoperative hospital stay and postoperative ICU stay were compared. Mean arterial pressure (MAP) was registered on the day before surgery, before anesthetic induction, during surgery, and upon admission in the intensive care unit (ICU). Although BP values did not differ significantly on the day before anesthesia, before induction and during operation, significantly more antihypertensive drugs were used for BP regulation in phaeochromocytoma patients versus the other tumor group. The phaeochromocytoma group required significantly more fentanyl during surgery (370±87 vs. 242±35 µg; p = 0.04). MAP upon ICU admission was significantly lower (85.1 vs. 97.4, p = 0.02) after adrenalectomy in phaeochromocytoma patients versus the other tumor group. The postoperative MAP decreased significantly in the phaeochromocytoma group (21.51 mmHg, p = 0.005), whereas significant differences according to preoperative values were not observed in the other tumor group (5.5 mmHg, p = 0.416). Prolonged preoperative hospital stay (24.6 vs. 10.0 days, p = 0.005) and ICU stay were registered in the phaeochromocytoma group. Pheochromocytoma patients had more pronounced perioperative BP oscillations, needed more antihypertensive drugs, analgesics and required prolonged hospital stay than patients with other adrenal tumors. Prolonged α-blockade may have contributed to these effects.
KeywordsSurgical procedures operative adrenalectomy Perioperative care Hypertension Antihypertensive agents Neuroendocrine tumors, phaeochromocytoma
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