Akashi Airi, Ono Yohei, Shimada Tetsuya, Takahashi Tetsuya, Ikeda Takahiko
Anesthesiology, National Defense Medical College, Tokorozawa, JPN.
Biostatistics and Bioinformatics, St. Luke's International University Graduate School of Public Health, Tokyo, JPN.
Cureus. 2025 May 12;17(5):e83995. doi: 10.7759/cureus.83995. eCollection 2025 May.
Pheochromocytomas and paragangliomas are uncommon neuroendocrine tumors that present notable anesthetic challenges, especially in controlling blood pressure. The Hypotension Prediction Index (HPI) can be used for intraoperative hemodynamic monitoring and management. Here, we report the case of a 46-year-old woman diagnosed with paraganglioma who underwent laparoscopic retroperitoneal resection guided by a monitoring system with HPI. Overall, mean arterial pressure (MAP) and HPI displayed an inverted relationship during the anesthesia induction period and subsequent phases of the procedure. Her MAP, initially around 90 mmHg, reached 120-150 mmHg while intubated and during tumor manipulation, and thus intermittent doses of phentolamine were necessary to control hypertensive events. MAP then declined following ligation of the tumor's feeding vessels, accompanied by a corresponding rise in HPI values. Intraoperative hypotension was managed by HPI-based protocols, resulting in a very low time-weighted average-MAP (TWA-MAP) below 65 mmHg of 0.007 mmHg. While the minimum cross-correlation value between HPI and MAP occurred at a time lag of zero, indicating no delay between HPI and MAP, we found HPI alerted 3 to 17 minutes before MAP reached below 65 mmHg. We could add a new insight into the interpretation of cross-correlation analysis, that no time delay between HPI and MAP might not necessarily mean the predictive ability of HPI was low. Whereas this case highlights the potential of the HPI in mitigating intraoperative hypotension, future research is necessary to evaluate its predictive accuracy during paragangliomas resection.
嗜铬细胞瘤和副神经节瘤是罕见的神经内分泌肿瘤，给麻醉带来了显著挑战，尤其是在控制血压方面。低血压预测指数（HPI）可用于术中血流动力学监测和管理。在此，我们报告一例46岁诊断为副神经节瘤的女性患者，其在HPI监测系统引导下接受了腹腔镜腹膜后切除术。总体而言，在麻醉诱导期及手术后续阶段，平均动脉压（MAP）与HPI呈反向关系。她的MAP最初约为90 mmHg，在插管时及肿瘤操作期间升至120 - 150 mmHg，因此需要间断给予酚妥拉明来控制高血压事件。在结扎肿瘤供血血管后，MAP随后下降，同时HPI值相应升高。术中低血压通过基于HPI的方案进行管理，导致时间加权平均MAP（TWA - MAP）非常低，低于65 mmHg的时间加权平均为0.007 mmHg。虽然HPI与MAP之间的最小互相关值出现在时间滞后为零的时候，表明HPI与MAP之间没有延迟，但我们发现HPI在MAP降至65 mmHg以下前3至17分钟发出警报。我们可以为互相关分析的解释增添新的见解，即HPI与MAP之间没有时间延迟不一定意味着HPI的预测能力低。尽管该病例突出了HPI在减轻术中低血压方面的潜力，但未来仍需开展研究以评估其在副神经节瘤切除术中的预测准确性。
