Drug Design, Development and Therapy (Oct 2022)
Non-Selective Alpha-Blockers Provide More Stable Intraoperative Hemodynamic Control Compared with Selective Alpha1-Blockers in Patients with Pheochromocytoma and Paraganglioma: A Single-Center Retrospective Cohort Study with a Propensity Score-Matched Analysis from China
Abstract
Yang Yang,1,2 Jie Zhang,3 Liqun Fang,2 Xue Jia,1,2 Wensheng Zhang1,2 1Laboratory of Anaesthesia & Critical Care Medicine, Translational Neuroscience Center, The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, People’s Republic of China; 2Department of Anaesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China; 3Department of Anaesthesiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, People’s Republic of ChinaCorrespondence: Wensheng Zhang, Laboratory of Anaesthesia & Critical Care Medicine, Translational Neuroscience Center, The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, People’s Republic of China, Tel/Fax +81-28-85164144, Email [email protected]: Alpha-adrenergic blockers are used in the preoperative preparation of patients with pheochromocytomas and paragangliomas (PPGLs) despite the controversial on perioperative hemodynamics. We aimed to determine whether selective or non-selective α-adrenergic blockers can provide better efficacy on patients’ intraoperative hemodynamics.Patients and Methods: This single-center retrospective study was conducted in 2507 adult patients undergoing PPGL resections, patients received alpha-adrenergic receptor blockers as a binary variable (selective or non-selective). Propensity score matching was performed and 201 patients were matched successfully.Results: A total of 201 patients with PPGL were included in this study. The HI score scores were higher in the selective group than in the non-selective group (60.5 [44.5– 84.0] vs 49.0 [37.0– 67.25], P=0.027), as well as in the hemodynamic variables section [14.0 [8.0– 20.0] vs 10 [6.0– 16.0], P=0.009). In terms of specific indicators for each component, the lowest MAP in the selective group (55± 10 mmHg vs 59± 8 mmHg, P=0.038), the time to MAP below 60 mmHg (0.011% vs 0.022%, P=0.033) and the use of other vasoconstrictors (56.5% vs 35.5%, P=0.019) were significantly lower than in the non-selective group. Among the secondary outcome indicators, the incidence of intraoperative maximum SBP was significantly higher in the selective group than in the non-selective group (32.3% vs 11.3%, P=0.005). There were no significant differences in postoperative outcome indicators between the two groups.Conclusion: In patients with PPGL, patients prepared preoperatively with non-selective alpha-blockers presented more stable hemodynamics intraoperatively compared to selective alpha1-blockers.Keywords: α-adrenergic blockers, PPGLs, hemodynamic instability, perioperative management
