preoperative factors associated with intraoperative maximum arterial pressures in patients with pheochromocytoma and paraganglioma

Background: surgery for pheochromocytoma and paraganglioma (ppgl) can lead to life-threatening complications, such as intraoperative hypertensive crises, even when adequate doses of preoperative α-receptor blockades are administered. objectives: the aim of this study was to identify preoperative factors associated with intraoperative maximum arterial pressure (ap) in patients with ppgl. methods: we retrospectively reviewed the cases of 61 ppgl patients who underwent surgical resection in our hospital between 2006 and 2020. the primary outcome was intraoperative maximum ap as a single index for continuous variables. simple and multiple linear regression model were used for statistical analysis. results: the median maximum systolic ap during surgery was 165 mmhg (interquartile range: 150 - 180 mmhg). log24-h urinary-fractionated metanephrine (mn) and normetanephrine (nmn) was correlated with intraoperative maximum ap (r-squared = 0.218, p < 0.001). multiple regression analyses showed that diabetes mellitus, one or more of the classic triad, and log24-h urinary-fractionated mn and nmn were independent factors associated with intraoperative maximum ap. conclusions: patients with ppgl accompanied by diabetes mellitus, one or more of the classic triad, and high log 24-h urinary-fractionated mn and nmn values may be at risk for hypertensive crises during surgery regardless of whether preoperative α-receptor blockades are used. clinicians should manage these patients more carefully and effectively.