Magnesium and dexmedetomidine combination reduces sodium nitroprusside requirement in laparoscopic pheochromocytoma

BACKGROUND: Anesthesia management of pheochromocytoma excision surgery is associated with severe hemodynamic fluctuations. The objective of this study is to compare the number of hypertensive crisis requiring sodium nitroprusside (SNP) administration between the groups treated with magnesium (Mg)-dexmedetomidine (Dex) and conventional group in pheochromocytoma.
METHODS: This retrospective cohort study included patients who underwent pheochromocytoma surgery between 2011 and 2020. Patients were examined into two groups: 1-Conventional group (GC) included patients who were operated between 2011 and 2015 under standard anesthesia care and who did not receive perioperative additional medication. 2- Mg-Dex therapy group (GMD) comprised the patients who were operated between 2015 and 2020 and who had received 300 mg Mg per oral daily 1 week before the surgery and Mg-Dex infusion intraoperatively. Blood pressure, heart rate (HR), and SNP requirement were recorded throughout surgery as well as demographics and operative data. Hypertensive crisis was defined as systolic blood pressure (SBP) >180 mmHg, and tachycardia was defined as HR >110 bpm.
RESULTS: A total of 78 patients’ data were analyzed from 108 patients’ documentary. (38 in GC, 40 in GMD) SNP requirement was significantly higher in GC (39.5%) comparing GMD (7.5%) (p=0.001). SBPs during tumor manipulation period were statistically higher in GC than in GMD at 10th, 15th, 20th, 25th, 30th, and 35th min. HR values were significantly higher in GC compared to GMD at 10th and 15th min of tumor manipulation period (p<0.05).
CONCLUSION: Combination of Mg-Dex seems to be an alternative therapy for reducing vasodilator requirement in perioperative management of pheochromocytoma.

Laparoskopik feokromositomada magnezyum ve deksmedetomidin kombinasyonu sodyum nitroprussid gereksinimini azaltýr

AMAÇ: Feokromasitoma eksizyon cerrahisinin anestezi yönetimi ciddi hemodinamik dalgalanmalarla iliþkilidir. Bu çalýþmanýn amacý, feokromasitomada magnezyum-deksmedetomidin ile tedavi edilen grup ile geleneksel grup arasýnda sodyum nitroprussid uygulamasý gerektiren hipertansif kriz sayýsýný karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Bu geriye dönük kohort çalýþmasý, 2011–2020 yýllarý arasýnda feokromasitoma ameliyatý geçiren hastalarý içermektedir. Hastalar iki gruba ayrýldý: 1- Geleneksel grup (GC); 2011–2015 yýllarý arasýnda standart anesteziyoloji hazýrlýðý ile ameliyat edilen ve perioperatif ek ilaç almayan hastalarý içeriyordu. 2-Magnezyum-deksmedetomidin tedavi grubu (GMD); 2015–2020 yýllarý arasýnda ameliyat edilen ameliyattan bir hafta önce günde oral 300 mg Magnezyum ve intraoperatif olarak magnezyum-deksmedetomidin infüzyonu alan hastalardan oluþuyordu. Ameliyat boyunca kan basýncý, kalp atým hýzý ve sodyum nitroprussid gereksinimi, demografik ve operatif veriler kaydedildi. Hipertansif kriz sistolik kan basýncý >180 mmHg, taþikardi ise kalp atým hýzý >110 atým olarak tanýmlandý.
BULGULAR: Toplam 108 hastanýn dökümanlarýndan 78 hastanýn verileri analiz edildi (GC’de 38, GMD’de 40 hasta). Sodyum nitroprussid gereksinimi GC’de (%39.5) GMD’ye (%7.5) göre anlamlý derecede yüksekti (p=0.001). Tümör manipülasyonu dönemindeki sistolik kan basýnçlarý, GC’de 10., 15., 20., 25., 30. ve 35. dakikalarda GMD’ye göre istatistiksel olarak daha yüksekti. Tümör manipülasyon periyodunun 10. ve 15. dakikalarýnda kalp atým hýzý deðerleri GC’de GMD’ye göre anlamlý derecede yüksekti (p<0.05).
TARTIÞMA: Magnezyum-deksmedetomidin kombinasyonu, feokromasitomanýn perioperatif yönetiminde vazodilatatör gereksinimini azaltmak için alternatif bir tedavi gibi görünmektedir.