Risk Factors For Persistent Hypotension During Pheochromocytoma Resection And Severe Post-high Lactate And Lactic Acidosis

Section I Risk factors of post-operative severe hyperlactatemia and lactic acidosis in patients undergoing laparoscopic resection of pheochromocytomaBackground Severe hyperlactatemia(SH)and lactic acidosis(LA)in patients undergone laparoscopic resection of pheochromocytoma is a severe and frequently reported complication.The study aims to investigate the incidence of this complication and to determine the potential clinical risk factors.Methods Patients who underwent laparoscopic resection for pheochromocytoma between 2011 and 2014 at Peking Union Medical College Hospital were enrolled.LA was defined as pH<7.35,bicarbonate<20 mmol/L,and serum lactate≥ 5 mmol/L;SH as lactate ≥ 5 mmol/L;and moderate hyperlactatemia(MH)as lactate 2.5-5.0 mmol/L without evidence of acidosis(pH>7.35 and/or bicarbonate>20 mmol/L).Data concerning patient demographics,clinical history,and laboratory results were collected and statistical analyses were performed.Results Out of 145 patients,59(40.7%)developed post-operative hyperlactatemia.The incidences of MH and SH/LA were 25.5%and 15.2%,respectively.Multivariate analysis demonstrated that body mass index(BMI)(odds ratio[OR],1.204;95%con dence interval[CI],1.016-1.426),24 h urine epinephrine concentration(OR,1.012;95%CI,1.002-1.022),and tumor size(OR,1.571;95%CI,1.102-2.240)were independent predictors of post-operative SH/LA.Conclusion The data show that post-operative SH/LA is not a rare complication after pheochromocytoma resection and may be closely associated with higher BMI,larger tumor size,and higher levels of urine epinephrine.These parameters may help clinicians assess and manage this patient population more effectively.Section II Risk factors for prolonged hypotension in patients undergoing laparoscopic resection of pheochromocytomaBackground Prolonged hypotension during pheochromocytoma resection is a severe complication.The study aims to investigate the predictors of prolonged hypotension in patients undergoing laparoscopic resection of pheochromocytoma.Methods Patients with who underwent laparoscopic resection of pheochromocytoma between 2012 and 2015 were surveyed.Patients were considered to have prolonged hypotension if they had a mean arterial blood pressure<60 mmHg or required ≥ 30 consecutive minutes of catecholamine support intraoperatively.Results Among 123 patients,54(43.9%)developed prolonged hypotension requiring>30 consecutive minutes for catecholamine support.Compared with patients with nonprolonged hypotension,those with prolonged hypotension had higher levels of urinary norepinephrine(p = 0.011),epinephrine(p<0.001),and dopamine(p = 0.019)preoperatively,and a higher incidence of vital organ injury postoperatively(p = 0.038).Multivariate logistic analysis showed that independent predictors for prolonged hypotension were multiples of the normal reference upper limit value of urinary epinephrine(odds ratio,1.180;95%confidence interval,1.035-1.345)and dopamine(odds ratio,4.375;95%confidence interval,1.207-15.855).Conclusion The levels of preoperative urinary epinephrine and dopamine are clinical predictors for prolonged hypotension in patients undergoing laparoscopic resection of pheochromocytoma.These parameters are beneficial to assess and manage this patient population more effectively.