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The association between the type of anesthesia and hemodynamic instability during pheochromocytoma surgery: a retrospective cohort study

  • 2021 EAES Poster
  • Published:
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Abstract

Background

Pheochromocytoma often carries a risk for perioperative hemodynamic instability (HDI). The aim of this study is to evaluate the risk factors of intraoperative HDI during minimally invasive posterior retroperitoneal adrenalectomy (PRA) for pheochromocytoma.

Materials and methods

This retrospective study analyzed the prospectively collected data of 172 patients who underwent laparoscopic PRA or robotic PRA for pheochromocytoma between January 2014 and December 2020 at a single tertiary center. The patients were divided into two groups according to the intraoperative hypertensive event of systolic blood pressure (> 160 mmHg). The clinical manifestations and perioperative hemodynamic conditions were analysed.

Results

In the multivariate logistic regression analysis, the tumor size (> 3.4 cm) [OR 3.14, 95% confidence intervals (CI) (1.48–6.64), p = 0.003], type of preoperative alpha-blocker (selective type) [OR 3.9, 95% CI (1.52–10.02), p = 0.005], preoperative use of beta-blockers [OR 3.94, 95% CI (1.07–14.49), p = 0.039] and type of anesthesia [total intravenous anesthesia (TIVA) vs. balanced anesthesia (BA)] [OR 2.57, 95% CI (1.23–5.38), p = 0.012] were determined as independent risk factors of intraoperative hypertensive events during minimally invasive adrenalectomy.

Conclusions

The type of anesthesia was independently associated with intraoperative HDI along with larger tumor size, type of preoperative alpha-blocker and the use of preoperative beta-blockers. TIVA increased the risk of intraoperative hypertensive events compared with BA. Thus, the consideration of the type of anesthesia prior to adrenal surgery for pheochromocytoma along with the use of preoperative non-selective alpha-blockers may be beneficial in minimizing the risk of intraoperative HDI.

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Funding

This study was supported by a grant from Asan Institute for Life Sciences and Corporate Relations of Asan Medical Center, Seoul, Korea.

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Authors and Affiliations

  1. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea

    Won Woong Kim, Jae Won Cho, Yu-mi Lee, Ki-Wook Chung & Tae-Yon Sung

  2. Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea

    Doo-Hwan Kim & Yeon Ju Kim

  3. Department of Surgery, UiJeongbu Eulji Medical Center, Eulji University, 712, Dongil-ro, Uijeongbu-si, 11759, Gyeonggi-do, Korea

    Cheong-Sil Rah & Suck Joon Hong

  4. Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea

    Jung-Min Koh & Seung Hun Lee

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  1. Won Woong Kim
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Correspondence to Yeon Ju Kim or Tae-Yon Sung.

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Disclosures

Won Woong Kim, Doo-Hwan Kim, Jae Won Cho, Cheong-Sil Rah, Yu-mi Lee, Ki-Wook Chung, Jung-Min Koh, Seung Hun Lee, Suck Joon Hong, Yeon Ju Kim, Tae-Yon Sung have no conflict of interest or financial ties to disclose.

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Informed consent was waived because this is a retrospective study.

Research involving human and animal participants

The study protocol was approved by the Institutional Review Board of Asan Medical Center, which waived the requirement for informed consent.

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Presented in poster format at the meeting of the 17th IFSES World Congress of Endoscopic Surgery (WCES 2021) in conjunction with the 29th International Congress of the European Association for Endoscopic Surgery (EAES) and incorporating the 16th Meeting of the section of Minimally Invasive Surgery and Technological Innovation of the Spanish Association for Surgery in Barcelona, Spain from November 24–27, 2021.

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Kim, W.W., Kim, DH., Cho, J.W. et al. The association between the type of anesthesia and hemodynamic instability during pheochromocytoma surgery: a retrospective cohort study. Surg Endosc 36, 5491–5500 (2022). https://doi.org/10.1007/s00464-021-08910-3

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