title: Preoperative Levels of Catecholamines and Metanephrines and Intraoperative Hemodynamics of Patients Undergoing Pheochromocytoma and Paraganglioma Resection.
abstract: OBJECTIVE
  To determine whether, despite pharmacologic adrenergic receptor blockade, higher preoperative levels of catecholamines and metanephrines (adrenergic activity) are associated with increased intraoperative complications.
  
  
  METHODS
  Records of patients undergoing paraganglioma and pheochromocytoma (PGL-PCC) resection from January 1, 2000, to June 30, 2015, were reviewed for preoperative levels of adrenergic activity, intraoperative variability in blood pressure and heart rate (range), and postoperative outcomes (hypotension requiring treatment). Patients were categorized by maximum preoperative adrenergic activity by greater degree of abnormality, categorized as normal (≤100%) or 101%-200%, 201%-500%, 501%-1000%, and ≥1001% of upper limit of normal.
  
  
  RESULTS
  In total, 258 patients underwent intrathoracic or intra-abdominal PGL-PCC resection, of whom 240 received pretreatment with nonselective α1,2-blockers and 7 received pretreatment with selective α1-blockers. Intraoperative hemodynamic variability was greater with higher preoperative levels of adrenergic activity (P <.001). However, substantial variability was observed even with adrenergic activity levels within the normal range: systolic blood pressure (median [interquartile range], 75 [63-83] mm Hg) and heart rate (34 [26-43] beats per minute). Among patients with preoperative levels of adrenergic activity ≤500% vs ≥501% of the upper limit of normal, higher levels were associated with greater likelihood of postoperative diagnosis of volume overload (8% vs 2%, P = .04) and greater requirement for vasopressor infusions for hypotension (5% vs 1%, P = .01).
  
  
  CONCLUSIONS
  Substantial intraoperative hemodynamic instability was encountered in patients with PGL-PCC resection, regardless of preoperative hormonal activity level; therefore, universal preoperative adrenergic receptor blockade should be recommended. Postoperative hypotension was rare and more prevalent in those with higher preoperative hormonal activity.
authors: Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
authors: Toby N
authors: TN
authors: Weingarten
authors: Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
authors: Tasha L
authors: TL
authors: Welch
authors: Mayo Clinic College of Medicine, School of Health Sciences, Nurse Anesthesia Graduate Programs, Rochester, MN.
authors: Tamara L
authors: TL
authors: Moore
authors: Mayo Clinic College of Medicine, School of Health Sciences, Nurse Anesthesia Graduate Programs, Rochester, MN.
authors: Gulshat F
authors: GF
authors: Walters
authors: Mayo Clinic College of Medicine, School of Health Sciences, Nurse Anesthesia Graduate Programs, Rochester, MN.
authors: Joni L
authors: JL
authors: Whipple
authors: Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
authors: Alexandre
authors: A
authors: Cavalcante
authors: Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN.
authors: Irina
authors: I
authors: Bancos
authors: Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN.
authors: William F
authors: WF
authors: Young
authors: Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors: Lucinda M
authors: LM
authors: Gruber
authors: Department of Endocrinology, Mayo Clinic, Rochester, MN.
authors: Muhammad Z
authors: MZ
authors: Shah
authors: Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN.
authors: Travis J
authors: TJ
authors: McKenzie
authors: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors: Darrell R
authors: DR
authors: Schroeder
authors: Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN. Electronic address: sprung.juraj@mayo.edu.
authors: Juraj
authors: J
authors: Sprung
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D018674:Adrenergic Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008676:Metanephrine / Q000097:blood*; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010235:Paraganglioma / Q000097:blood* / Q000503:physiopathology / Q000601:surgery*; D010673:Pheochromocytoma / Q000097:blood* / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D018674:Adrenergic Antagonists; D008676:Metanephrine