SAT306 Comparison Of Sodium Nitroprusside And Urapidil In Laparoscopic Adrenalectomy For Pheochromocytoma

Abstract

Abstract Disclosure: M.G. Rusalenko: None. E. Pispanen: None. M. Wisham: None. I. Savasteeva: None. S. Marchenko: None. D. Borovik: None. D.O. Rusalenko: None. The aim: of the study was to compare the efficacy of Sodium Nitroprusside and Urapidil in management of blood pressure in laparoscopic adrenalectomy for pheochromocytoma. Material and methods : This study includes of 58 cases of pheochromocytoma operated in the Republican Scientific and Practical Center for Radiation Medicine. The mean age of patients was 57.0 years (31 men and 27 women). For preliminary preparations, oral α1-blocker Doxazosin was used. In-operative blood pressure (BP) was recorded via intra-radial artery BP monitoring and via intra-venous BP monitoring from the external jugular vein. Fluid loading was done with colloids and crystalloids. Epidural anesthesia was given with a combination of Ropivacaine 10mg/ml-10ml and Spinal Morphine 1mg/ml-1-2ml was given between T4 - T5 for relaxation of the abdominal cavity. For anesthesia Sevoflurane was used with non-depolarizing short and medium-acting muscle relaxants (rocuronium, atracurium). In the study we included 12 patients who underwent surgery under BP control with Uradipil and 46 patients with Nitroprusside. Results: Long-term administered Doxazosin (more than 14 days) demonstrated lower BP values ​​in the starting phase of the operations (SBP 125.0[110.0; 130.0]; DBP [75.0(60.0; 80.0]) § (SBP 140.0[130.0; 150.0]; DBP [90.0(80.0; 90.0]); p<0.05. Statistically significant differences in BP variability from baseline to maximum values, as well as minimum values were obtained. In both groups (Nitroprusside and Urapidil), using the Wilcoxon criteria, we did not obtain significant differences in the increase in the initial blood pressure in maximum values. In contrast, in the Nitroprusside group, a statistically significant decrease in baseline blood pressure to the minimum values (SBP 90.0[75.0; 100.0]; DBP [50.0(50.0; 55.0]); p<0.004) was obtained, as in the Urapidil group: (SBP 130.0[ 110.0; 140.0]; DBP [80.0(60.0; 90.0]), to minimal values (SBP 95.0[90.0; 110.0]; DBP [60.0(50.0; 60.0]); p<0.008. Comparison of all blood pressure indicators when using Nitroprusside or Urapidil using the Mann-Whitney U test did not show statistically significant differences. However, there was a minor significance in minimum SBP values ​​(N 90.0[75.0; 100.0] § [U 95.0(90.0; 110.0]); z=-1.44; p=0.15) and DBP (N 50.0[50.0; 55.0] § [U 60.0(50.0; 60.0]); z=-1.81; p=0.07. Initial, maximum and final BP values ​​were equivalent in two groups. Conclusion: This data shows that to stabilize patient blood pressure in adrenalectomy for pheochromocytoma, preparation with α1-blockers is significant. The use of Sodium Nitroprusside and Urapidil is equally effective for managing BP during adrenalectomy, however, Urapidil shows to have advantages due to its lower side effects compared to Nitroprusside. Presentation: Saturday, June 17, 2023