47.09 Epidural anesthesia is safe in open resection of pheochromocytoma and abdominal paraganglioma

Posted on January 31, 2019

D. Wiseman1, J. McDonald1, D. Patel1, E. Kebebew3, K. Pacak2, N. Nilubol1  1National Cancer Institute,Bethesda, MD, USA 2National Institute of Child Health and Human Development,Bethesda, MD, USA 3Stanford University,Surgery,Palo Alto, CA, USA

Introduction:

The most common side effect of epidural anesthesia (EA) is hypotension. Because hypotension frequently occurs after a removal of pheochromocytoma-paraganglioma (PPGLs) from the alpha-adrenergic blockade and the abrupt reduction of catecholamine production, we aimed to determine if EA is associated with an increased risk of postoperative hypotension and complications from postoperative fluid overload.

Methods:

We performed a retrospective review of a prospectively collected cohort of patients who underwent open resections of PPGLs from 2009-2018.  The EA infusion started before patient transfer to ICU. Clinical characteristics, tumor burden, and perioperative parameters were analyzed by the use of EA. The primary endpoint was postoperative hypotension.

Results:

Of 66 patients who underwent open resections of PPGLs, 52 (78.8%%) received EA. No differences in patient demographics and clinical characteristics were found by the use of EA except the significantly lower rate of EA used in patients with von Hippel-Lindau disease due to the presence of spinal hemangioblastoma (0% vs. 82.5%, p=0.008) and a higher rate of EA use in patients undergoing reoperation (85.7% vs. 58.8%, p=0.035). We found that postoperative hypotension was common following open resections of abdominal PPGLs (56.9%). However, there was no difference in the rates of postoperative hypotension by the use of EA (58.8% in EA group vs. 50.0% in non-EA group, p=0.561), the need for postoperative vasopressor (p=1.00) or diuretics (p=0.111), postoperative weight gain (p=0.436), hypoxia (p=0.703), or the volume of IV fluid in the first 24 hours postoperatively (p=0.903). EA was stopped because of postoperative hypotension in 13.6% of patients.

Conclusion:

Although postoperative hypotension is common after open resection of PPGLs, EA is safe as it was not associated with increased risk of postoperative hypotension or fluid overload.