Epidural anesthesia and hypotension in pheochromocytoma and paraganglioma

in Endocrine-Related Cancer
Authors:
Douglas Wiseman National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA

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James D McDonald National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA

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https://orcid.org/0000-0002-6193-4152
,
Dhaval Patel National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA

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Electron Kebebew Stanford University School of Medicine, Stanford, California, USA

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Karel Pacak Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA

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Naris Nilubol National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA

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Correspondence should be addressed to N Nilubol: naris.nilubol@nih.gov

*(D Wiseman and J D McDonald contributed equally to this work)

DOI:
https://doi.org/10.1530/ERC-20-0139
Volume/Issue:
Volume 27: Issue 9
Article Type:
Research Article
Page Range:
519–527
Online Publication Date:
Sep 2020
Copyright:
© 2020 Society for Endocrinology 2020
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Postoperative hypotension frequently occurs after resection of pheochromocytoma and/or paraganglioma (PPGLs). Epidural anesthesia (EA) is often used for pain control in open resection of these tumors; one of its side effects is hypotension. Our aim is to determine if EA is associated with an increased risk of postoperative hypotension after open resection of PPGLs. We conducted a retrospective review of patients who underwent open resection of PPGLs at the National Institutes of Health from 2004 to 2019. Clinical and perioperative parameters were analyzed by the use of EA. The primary endpoint was postoperative hypotension. Ninety-seven patients (46 female and 51 male; mean age, 38.5 years) underwent open resection of PPGLs and 69 (71.1%) received EA. Patients with EA had a higher rate beta-blocker use (79.7% vs 57.1%, P = 0.041), metastasis (69.6% vs 39.3%, P = 0.011), and were more frequently hypotensive after surgery (58.8% vs 25.0%, P = 0.003) compared to those without EA. Patients with postoperative hypotension had higher plasma normetanephrines than those without (7.3 fold vs 4.1 fold above the upper limit of normal, P = 0.018). Independent factors associated with postoperative hypotension include the use of beta-blockers (HR = 3.35 (95% CI: 1.16–9.67), P = 0.026) and EA (HR = 3.49 (95% CI: 1.25–9.76), P = 0.017). Data from this retrospective study suggest that, in patients with open resection of PPGLs, EA is an independent risk factor for early postoperative hypotension. Special caution is required in patients on beta-blockade. A prospective evaluation with standardized protocols for the use of EA and management of hemodynamic variability is necessary.

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Print ISSN:
1351-0088
Online ISSN:
1479-6821
Copyright:
© 2020 Society for Endocrinology 2020
Page(s):
9
Received Date:
12 May 2020
Accepted Date:
14 May 2020
Print Publication Date:
01 Sep 2020
Online Publication Date:
Sep 2020
Keywords:
epidurals; pheochromocytoma; paraganglioma; SDHB

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