Differences in 5-Aminolevulinic Acid-Induced Hemodynamic Changes between Patients Undergoing Neurosurgery and Urological Surgery

Tohru Shiratori; Kunihisa Hotta; Masaaki Satoh; Atsushi Sato; Takayuki Kamigaito; Chiaki Kiuchi; Ryusuke Tanaka

doi:10.31662/jmaj.2021-0092

Differences in 5-Aminolevulinic Acid-Induced Hemodynamic Changes between Patients Undergoing Neurosurgery and Urological Surgery

JMA J. 2021 Oct 15;4(4):374-386. doi: 10.31662/jmaj.2021-0092. Epub 2021 Sep 27.

Authors

Tohru Shiratori¹, Kunihisa Hotta², Masaaki Satoh², Atsushi Sato³, Takayuki Kamigaito⁴, Chiaki Kiuchi¹, Ryusuke Tanaka¹

Affiliations

¹ Department of Anesthesiology, Ina Central Hospital, Nagano, Japan.
² Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Tochigi, Japan.
³ Department of Neurosurgery, Ina Central Hospital, Nagano, Japan.
⁴ Department of Urology, Ina Central Hospital, Nagano, Japan.

Abstract

Introduction: Oral 5-aminolevulinic acid (5-ALA) is often used for photodynamic diagnosis-assisted glioma or bladder tumor surgery. 5-ALA affects blood pressure (BP). In fact, hypotension is a well-known adverse effect of 5-ALA in urology. However, information regarding 5-ALA-induced hemodynamic changes in neurosurgery remains limited. Furthermore, the duration of hypotension and how 5-ALA affects the heart rate (HR) are yet to be determined. Thus, in this study, we aimed to elucidate 5-ALA-induced perioperative hemodynamic changes in neurosurgery and urological surgery by examining real-world data.

Methods: Consecutive patients who underwent neurosurgery (neurosurgery patients; 5-ALA-pretreated vs. non-pretreated [17 vs. 16], from January 2014 to March 2021) and urological surgery (urological surgery patients; 5-ALA-pretreated vs. non-pretreated [26 vs. 101], from August 2018 to September 2020) were enrolled. Differences in hemodynamics were evaluated using the linear mixed model. BP and HR in 5-ALA-pretreated patients were compared with those in non-pretreated patients. Differences in 5-ALA-induced preoperative BP changes were compared between the neurosurgery patients and urological surgery patients.

Results: 5-ALA scarcely affected the hemodynamics in neurosurgery patients, whereas 5-ALA-induced hemodynamic changes were clearly observed in urological surgery patients. Hemodynamic parameters were found to be not significantly different between 5-ALA-pretreated and non-pretreated neurosurgery patients. The preoperative, intraoperative, and postoperative BP in 5-ALA-pretreated urological surgery patients were significantly lower than those in the non-pretreated patients. Preoperatively, two 5-ALA-pretreated urological surgery patients had severe postural hypotension (systolic BP <50 mmHg), and one of them did not continue with the surgery because of prolonged severe hypotension. The BP in 5-ALA-pretreated urological surgery patients tended to be persistently lower for 9 h after 5-ALA pretreatment. The preoperative and postoperative HR values were higher in 5-ALA-pretreated urological surgery patients. Cumulative incidences of BP reduction and HR elevation were significantly higher in 5-ALA-pretreated urological surgery patients. The preoperative BP reduction in 5-ALA-pretreated urological surgery patients was significantly larger than that in neurosurgery patients.

Conclusions: 5-ALA-induced hemodynamics may differ between neurosurgery patients and urological surgery patients. 5-ALA may affect BP for at least 9 h.

Keywords: Aminolevulinic acid; blood pressure; glioma; heart rate; hemodynamics; hypotension; photodynamic therapy; urinary bladder neoplasms.