The Relationship Between Preoperative Preparation And Prevention Of Intraoperative Hypotension In Patients Undergoing Laparoscopic Pheocbromocytoma Resection:A Retrospective Study

Objective:Laparoscopic resection is the most effective treatment for adrenal pheochromocytoma.The maintenance of intraoperative hemodynamic stability is the key to the success of surgery and the safety of anesthesia.Adequate preoperative preparation is crucial to the intraoperative hemodynamic stability.It can effectively prevent hypotension after tumor resection.The purpose of this retrospective study was to determine the relationship between the control degree of preoperative related factors and intraoperative hypotension in laparoscopic pheochromocytoma resection.Methods:patients' general information(including age,gender,ASA,preoperative plasma catecholamine content,CT shown in tumor diameter and location,etc.)and the clinical symptoms,complications,preoperative medication,fluid expansion were settled,and the preoperative blood pressure,heart rate,body weight change(body weight change=(preoperative weight-hospital weight)/hospital weight)and hematocrit were tested.61 patients undergoing laparoscopic surgery received the same basic monitoring,including body temperature,electrocardiogram,pulse oxygen saturation,end-tidal carbon dioxide partial pressure,and more advanced hemodynamic monitoring,including continuous monitoring of blood pressure and heart rate,central venous pressure.In addition,the operative time,bleeding volume and urine output during operation,and the use of vasoactive drugs,anesthetic drugs,and dilatation for blood pressure fluctuations by anesthesiologists were recorded.Paired t-test was used to compare the indicators before and after preoperative preparation,and chi-square test and Fisher precise test were used to compare the relationship between the indicators after preoperative preparation and intraoperative hypotension,as well as the pairwise comparison of the indicators after grouping.Postoperative admission to ICU,blood pressure and heart rate after surgery,perioperative complications,length of stay,blood pressure and heart rate at discharge,and in-hospital mortality were recorded.Results:Blood pressure,heart rate,body weight and hematocrit which were from before and after preoperative preparation were compared,and the results showed that blood pressure,body weight and hematocrit had statistical difference(P<0.05),but heart rate had no statistical difference(P>0.05).Blood pressure,heart rate,body weight change and hematocrit after preoperative preparation and the incidence of intraoperative hypotension were statistically different(P<0.05).Then,Blood pressure,heart rate,body weight change and hematocrit were grouped and were pairwise compared.The incidence of intraoperative hypotension with preoperative systolic blood pressure lower than 130 mmHg and/or diastolic blood pressure lower than 85 mmHg was less than preoperative systolic blood pressure more than 140 mmHg and/or diastolic blood pressure more than 90 mmHg(P<0.05).The incidence of intraoperative hypotension with preoperative body weight increase>2%was less than that of no weight gain(P<0.05).Heart rate were controlled at 60?100 beats/min,there was no statistical difference grouped as follows for the prevention of intraoperative hypotension.Hematocrit were controlled at 25%?45%,there was no statistical difference grouped as follows for the prevention of intraoperative hypotension.Conclusions:According to this study,the risk of IOH was reduced when preoperative systolic blood pressure was lower than 130 mmHg and/or diastolic blood pressure was lower than 85 mmHg and body weight change was more than 2.00%.The incidence of intraoperative hypotension showed no statistical difference while heart rate was between 60 and 100 beats/min and hematocrit was between 25.00%and 45.00%.Our study findings will guide the clinical treatment of pheochromocytoma.