title: Hemodynamic Stability During Pheochromocytoma Resection: Lessons Learned Over the Last Two Decades.
abstract: BACKGROUND
  Ideal perioperative management of pheochromocytomas/paragangliomas (pheo) is a subject of debate and can be highly variable. The purpose of this study was to identify potential predictive factors of hemodynamic instability during pheo resection.
  
  
  METHODS
  A retrospective review of pheo resections from 1992 to 2013 was undertaken. Intraoperative hemodynamics, patient demographics, tumor characteristics, and perioperative management were examined. Postoperative intensive-care admission, myocardial infarction, stroke, and 30-day mortality were reviewed. Linear regression was used to analyze factors influencing intraoperative hemodynamics.
  
  
  RESULTS
  During the 20-year study period, 100 patients underwent pheo resection. Postoperative morbidity and mortality was significantly reduced (p = 0.003) in the last 10 years of practice, and there was a trend towards greater morbidity and mortality with intraoperative hemodynamic instability (p = 0.06). The preoperative dose of phenoxybenzamine and the number of laparoscopic procedures has increased in the last decade [59 mg (95 % CI 32-108) to 106 mg (95 % CI 91-124), p = 0.008, and 27 vs. 54 %, p = 0.05, respectively]. Increased preoperative phenoxybenzamine dose was a significant predictor of improved intraoperative hemodynamic stability (p = 0.01). Lack of intraoperative magnesium use resulted in greater hemodynamic instability as preoperative systolic blood pressure increased (p = 0.002).
  
  
  CONCLUSIONS
  Postoperative outcomes following pheo resection have improved over the last two decades. Preoperative α-blockade plays a significant role in improving intraoperative hemodynamics and post-op outcomes. Increased doses of phenoxybenzamine and utilization of laparoscopic approaches have likely contributed to improved outcomes in the last decade. Intraoperative magnesium use may provide protection against hemodynamic instability and warrants further study.
authors.affiliation: University of Calgary, 1403 - 29 Street NW, Calgary, AB, T2N 2T9, Canada. Meggie.livingstone@albertahealthservices.ca.
authors.forename: Margaret
authors.initials: M
authors.lastname: Livingstone
authors.affiliation: University of Calgary, 1403 - 29 Street NW, Calgary, AB, T2N 2T9, Canada.
authors.forename: Kaylene
authors.initials: K
authors.lastname: Duttchen
authors.affiliation: University of Calgary, 1403 - 29 Street NW, Calgary, AB, T2N 2T9, Canada.
authors.forename: Jenny
authors.initials: J
authors.lastname: Thompson
authors.affiliation: University of Calgary, 1403 - 29 Street NW, Calgary, AB, T2N 2T9, Canada.
authors.forename: Zahid
authors.initials: Z
authors.lastname: Sunderani
authors.affiliation: University of Calgary, 1403 - 29 Street NW, Calgary, AB, T2N 2T9, Canada.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Hawboldt
authors.affiliation: Alberta Health Services, Calgary, AB, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Sarah Rose
authors.affiliation: University of Calgary, 1403 - 29 Street NW, Calgary, AB, T2N 2T9, Canada.
authors.forename: Janice
authors.initials: J
authors.lastname: Pasieka
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D000315:Adrenalectomy; D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009367:Neoplasm Staging; D010643:Phenoxybenzamine / Q000008:administration & dosage; D010673:Pheochromocytoma / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D000317:Adrenergic alpha-Antagonists; D010643:Phenoxybenzamine