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Clinical predictors of prolonged postresection hypotension after laparoscopic adrenalectomy for pheochromocytoma
- Source :
- Surgery. 159:763-770
- Publication Year :
- 2016
- Publisher :
- Elsevier BV, 2016.
-
Abstract
- Background Although the perioperative management of patients with pheochromocytoma has been improving recently, severe hypotensive episodes can occur that require postoperative catecholamine support and are challenging to manage. Our aim was to identify the clinical factors that predict prolonged postresection hypotension in patients after laparoscopic adrenalectomy for pheochromocytoma. Methods The records of 73 Japanese patients who underwent unilateral laparoscopic adrenalectomy for pheochromocytoma were surveyed retrospectively. Patients were divided into 2 groups according to whether catecholamine support was needed after postoperatively. Clinical and biochemical data were evaluated at baseline and after operation. Results Thirty-four of 73 patients (47%) required continuous infusion of catecholamine to maintain systolic blood pressure >90 mm Hg at the end of the operation. The median duration of postoperative catecholamine support was 17 hours (range, 3–130) in these 34 patients. On multivariate analysis, tumor size >60 mm, urinary epinephrine levels >200 μg/day, and urinary norepinephrine levels >600 μg/day were independent predictors of prolonged hypotension requiring postoperative catecholamine support. Tumor size and urinary norepinephrine levels were significantly correlated with the duration of postoperative catecholamine support. Conclusion Larger tumor size and greater values of urinary epinephrine and norepinephrine levels were significant predictors of prolonged hypotension requiring postoperative catecholamine support. Moreover, tumor size and urinary norepinephrine levels were positively correlated with the duration of postoperative catecholamine support. Clinicians can identify and manage patients more effectively with a greater risk of prolonged hypotension after tumor resection using these preoperative clinical variables.
- Subjects :
- Adult
Male
Adolescent
Epinephrine
medicine.medical_treatment
Urinary system
Adrenal Gland Neoplasms
Pheochromocytoma
Cohort Studies
Norepinephrine (medication)
Norepinephrine
Young Adult
03 medical and health sciences
Catecholamines
Postoperative Complications
0302 clinical medicine
Japan
Predictive Value of Tests
medicine
Humans
Infusions, Intravenous
Aged
Retrospective Studies
Analysis of Variance
business.industry
Adrenalectomy
Middle Aged
medicine.disease
Blood pressure
ROC Curve
030220 oncology & carcinogenesis
Predictive value of tests
Anesthesia
Multivariate Analysis
Catecholamine
Female
Laparoscopy
030211 gastroenterology & hepatology
Surgery
Hypotension
business
Biomarkers
medicine.drug
Subjects
Details
- ISSN :
- 00396060
- Volume :
- 159
- Database :
- OpenAIRE
- Journal :
- Surgery
- Accession number :
- edsair.doi.dedup.....5581b18b238280b825fe8e13fc1fb5d9