Details

Autor(en) / Beteiligte

• Morisawa, Shumpei
• Jobu, Kohei
• Ishida, Tomoaki
• Kawada, Kei
• Fukuda, Hitoshi
• Kawanishi, Yu
• Nakayama, Taku
• Yamamoto, Shinkuro
• Tamura, Naohisa
• Takemura, Mitsuhiro
• Kagimoto, Nao
• Ohta, Tsuyoshi
• Masahira, Noritaka
• Fukuhara, Hideo
• Ogura, Shun-ichiro
• Ueba, Tetsuya
• Inoue, Keiji
• Miyamura, Mitsuhiko

Titel

Association of 5-aminolevulinic acid with intraoperative hypotension in malignant glioma surgery

Ist Teil von

• Photodiagnosis and photodynamic therapy, 2022-03, Vol.37, p.102657-102657, Article 102657

Ort / Verlag

Netherlands: Elsevier B.V

Erscheinungsjahr

2022

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• •5-ALA was associated with low blood pressure in malignant glioma surgery.•Intraoperative hypotension was associated with increasing age.•RAS inhibitors boost the blood pressure-lowering effect of 5-ALA.•5-ALA associated with low blood pressure may be mediated by NO in endothelial cells. Use of 5-aminolevulinic acid for photodynamic malignant tumor diagnosis reportedly causes intraoperative hypotension (systolic blood pressure < 70 mmHg) during urologic surgery. However, its association with intraoperative hypotension in malignant glioma surgery and underlying mechanisms has not yet been elucidated.. This study aimed to investigate whether 5-aminolevulinic acid administration is associated with intraoperative hypotension in malignant glioma surgery and explore the mechanisms of 5-aminolevulinic acid-induced hypotension in vitro. In this retrospective multicenter cohort study, we investigated intracellular nitric oxide as a candidate mediator of hypotension in response to 5-aminolevulinic acid in vitro in human umbilical vein endothelial cell cultures. Of 142 patients, 94 underwent 5-aminolevulinic acid-guided surgery. Systolic blood pressure was significantly lower throughout surgery with 5-aminolevulinic acid administration. 5-Aminolevulinic acid administration was an independent risk factor for intraoperative hypotension according to multivariable logistic regression analysis (89% vs. 56%; odds ratio = 6.72, 95% confidence interval [2.05–22.1], P = 002). In subgroup analysis of the 5-aminolevulinic acid group, increasing age and use of renin-angiotensin system inhibitors had a synergistic effect with 5-aminolevulinic acid on decreased blood pressure. In the vascular endothelial cell culture study, 5-aminolevulinic acid induced a significant increase in intracellular nitric oxide generation. 5-Aminolevulinic acid administration was associated with intraoperative hypotension in malignant glioma surgery, with increasing age and use of renin-angiotensin system inhibitors boosting the blood pressure-lowering effect of 5-aminolevulinic acid. According to in vitro results, the low blood pressure induced by 5-aminolevulinic acid may be mediated by a nitric oxide increase in vascular endothelial cells.