Deliberate Compensated Vasoplegia - a Novel Pharmacological Regimen for Controlling Arterial Blood Pressure During Surgery for Pheochromocytoma

Abstract

Abstract Background: Intraoperative hemodynamic fluctuations are the most dreaded phenomenon associated with the treatment of pheochromocytoma. Preoperative alpha-adrenergic blockade protocols aimed at abating these fluctuations have achieved controversial results. No study to date has evaluated the use of intraoperative treatment protocols during surgery for pheochromocytoma. Deliberate compensated vasoplegia (DCV) is a novel pharmacological regimen developed at our institution intended to decrease severe hypertensive events. The aim of this study is to compare outcomes of pheochromocytoma resection with and without the DCV protocol. Methods: A retrospective analysis of all pheochromocytoma resections between the years 2012 and 2020 was performed. Resections performed with and without the DCV protocol were compared. The primary outcome measured was the incidence of severe intraoperative hypertension (mean arterial pressure ≥ 150 mmHg). Secondary outcomes included other abnormal blood pressure measurements as well as perioperative data and complications. Results: A total of 41 pheochromocytoma resections were included: 21 performed using standard practice and 20 with the DCV protocol. Analysis demonstrated no significant difference in preoperative parameters including tumor size, catecholamine levels, or alpha-blockade protocol. The use of the DCV protocol resulted in a significant decrease in the incidence of severe hypertensive episodes from 1.95±3.6 to 0.03±0.13 events/hour (p=0.008). The DCV protocol was not associated with any adverse events. Conclusions: This study demonstrates that DCV anesthesia protocol significantly decreases the incidence of severe hypertensive episodes during pheochromocytoma resection. This is the first study describing a highly effective protocol for controlling intraoperative hypertension and hemodynamic instability in pheochromocytoma patients.