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Article: High pre-operative urinary norepinephrine is an independent determinant of peri-operative hemodynamic instability in unilateral pheochromocytoma/paraganglioma removal
Title | High pre-operative urinary norepinephrine is an independent determinant of peri-operative hemodynamic instability in unilateral pheochromocytoma/paraganglioma removal |
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Authors | |
Issue Date | 2014 |
Publisher | Springer New York LLC. The Journal's web site is located at http://link.springer.de/link/service/journals/00268/ |
Citation | World Journal of Surgery, 2014, v. 38, n. 9, p. 2317-2323 How to Cite? |
Abstract | Background: Peri-operative hemodynamic instability (HDI) may increase peri-operative morbidity in pheochromocytoma/paraganglioma (PPGL) patients. Objective: This study aimed to determine which tumor-related risk factors could lead to peri-operative HDI in unilateral or single PPGL removal. Methods: Before surgery, 66 PPGL patients had at least two sets of 24 h urine collected for fractionated catecholamine analysis. At surgery, an arterial line was inserted to record systolic blood pressure (SBP), diastolic BP, and mean arterial BP (MAP). Peri-operative HDI was defined as hypertension (SBP > 160 mmHg) and/or hypotension (SBP < 90 mmHg and/or MAP < 60 mmHg) for >10 consecutive minutes either intra-operatively or within the first 12 h after surgery. Urinary fractionated catecholamines and other variables were compared between those with peri-operative HDI (group I) and those without (group II). Results: A total of 15 (22.7 %) patients belonged to group I, while 51 patients belonged to group II. One (1.5 %) patient died 9 days after surgery. Relative to group II, group I had significantly higher urinary norepinephrine (NE) (5,488.0 vs. 1,980.0 nmol/L, p < 0.001), urinary normetanephrine (5,130.9 vs. 3,853.4 nmol/L, p = 0.045), maximum SBP at operation (188.2 vs. 167.4 mmHg, p = 0.037), but lower MAP after operation (78.9 vs. 91.8 mmHg, p = 0.026). Urinary NE (OD 1.02, 95 % confidence interval [CI] 1.01-1.03, p = 0.046) was an independent risk factor for peri-operative HDI. The urinary NE level significantly correlated with maximum intra-operative SBP and MAP (r 0.692, p < 0.001; and r 0.669, p < 0.001, respectively) and inversely correlated with maximum post-operative MAP (r -0.305, p = 0.040). Conclusions: High pre-operative urinary NE was an independent tumor-related factor for peri-operative HDI and significantly correlated with sustained intra-operative hypertension and post-operative hypotension. © 2014 Société Internationale de Chirurgie. |
Persistent Identifier | http://hdl.handle.net/10722/197648 |
ISSN | 2023 Impact Factor: 2.3 2023 SCImago Journal Rankings: 0.772 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Chang, RY | en_US |
dc.contributor.author | Lang, HHB | en_US |
dc.contributor.author | Wong, KP | en_US |
dc.contributor.author | Lo, CY | en_US |
dc.date.accessioned | 2014-05-29T08:35:22Z | - |
dc.date.available | 2014-05-29T08:35:22Z | - |
dc.date.issued | 2014 | en_US |
dc.identifier.citation | World Journal of Surgery, 2014, v. 38, n. 9, p. 2317-2323 | en_US |
dc.identifier.issn | 0364-2313 | en_US |
dc.identifier.uri | http://hdl.handle.net/10722/197648 | - |
dc.description.abstract | Background: Peri-operative hemodynamic instability (HDI) may increase peri-operative morbidity in pheochromocytoma/paraganglioma (PPGL) patients. Objective: This study aimed to determine which tumor-related risk factors could lead to peri-operative HDI in unilateral or single PPGL removal. Methods: Before surgery, 66 PPGL patients had at least two sets of 24 h urine collected for fractionated catecholamine analysis. At surgery, an arterial line was inserted to record systolic blood pressure (SBP), diastolic BP, and mean arterial BP (MAP). Peri-operative HDI was defined as hypertension (SBP > 160 mmHg) and/or hypotension (SBP < 90 mmHg and/or MAP < 60 mmHg) for >10 consecutive minutes either intra-operatively or within the first 12 h after surgery. Urinary fractionated catecholamines and other variables were compared between those with peri-operative HDI (group I) and those without (group II). Results: A total of 15 (22.7 %) patients belonged to group I, while 51 patients belonged to group II. One (1.5 %) patient died 9 days after surgery. Relative to group II, group I had significantly higher urinary norepinephrine (NE) (5,488.0 vs. 1,980.0 nmol/L, p < 0.001), urinary normetanephrine (5,130.9 vs. 3,853.4 nmol/L, p = 0.045), maximum SBP at operation (188.2 vs. 167.4 mmHg, p = 0.037), but lower MAP after operation (78.9 vs. 91.8 mmHg, p = 0.026). Urinary NE (OD 1.02, 95 % confidence interval [CI] 1.01-1.03, p = 0.046) was an independent risk factor for peri-operative HDI. The urinary NE level significantly correlated with maximum intra-operative SBP and MAP (r 0.692, p < 0.001; and r 0.669, p < 0.001, respectively) and inversely correlated with maximum post-operative MAP (r -0.305, p = 0.040). Conclusions: High pre-operative urinary NE was an independent tumor-related factor for peri-operative HDI and significantly correlated with sustained intra-operative hypertension and post-operative hypotension. © 2014 Société Internationale de Chirurgie. | - |
dc.language | eng | en_US |
dc.publisher | Springer New York LLC. The Journal's web site is located at http://link.springer.de/link/service/journals/00268/ | en_US |
dc.relation.ispartof | World Journal of Surgery | en_US |
dc.rights | The original publication is available at www.springerlink.com | en_US |
dc.title | High pre-operative urinary norepinephrine is an independent determinant of peri-operative hemodynamic instability in unilateral pheochromocytoma/paraganglioma removal | en_US |
dc.type | Article | en_US |
dc.identifier.email | Lang, HHB: Blang@hku.hk | en_US |
dc.identifier.email | Lo, CY: cylo@hkucc.hku.hk | en_US |
dc.identifier.authority | Lang, HHB=rp01828 | en_US |
dc.identifier.doi | 10.1007/s00268-014-2597-9 | - |
dc.identifier.scopus | eid_2-s2.0-84905657666 | - |
dc.identifier.hkuros | 228781 | en_US |
dc.identifier.hkuros | 228780 | - |
dc.identifier.volume | 38 | en_US |
dc.identifier.isi | WOS:000340421700019 | - |
dc.publisher.place | United States | en_US |
dc.identifier.issnl | 0364-2313 | - |