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Morisawa S, Jobu K, Ishida T, et al. Association of 5-aminolevulinic acid with intraoperative hypotension in malignant glioma surgery. Photodiagnosis Photodyn Ther. 2021;37:102657doi: 10.1016/j.pdpdt.2021.102657.
Morisawa, S., Jobu, K., Ishida, T., Kawada, K., Fukuda, H., Kawanishi, Y., Nakayama, T., Yamamoto, S., Tamura, N., Takemura, M., Kagimoto, N., Ohta, T., Masahira, N., Fukuhara, H., Ogura, S. I., Ueba, T., Inoue, K., & Miyamura, M. (2021). Association of 5-aminolevulinic acid with intraoperative hypotension in malignant glioma surgery. Photodiagnosis and photodynamic therapy, 37102657. https://doi.org/10.1016/j.pdpdt.2021.102657
Morisawa, Shumpei, et al. "Association of 5-aminolevulinic acid with intraoperative hypotension in malignant glioma surgery." Photodiagnosis and photodynamic therapy vol. 37 (2021): 102657. doi: https://doi.org/10.1016/j.pdpdt.2021.102657
Morisawa S, Jobu K, Ishida T, Kawada K, Fukuda H, Kawanishi Y, Nakayama T, Yamamoto S, Tamura N, Takemura M, Kagimoto N, Ohta T, Masahira N, Fukuhara H, Ogura SI, Ueba T, Inoue K, Miyamura M. Association of 5-aminolevulinic acid with intraoperative hypotension in malignant glioma surgery. Photodiagnosis Photodyn Ther. 2021 Nov 27;37:102657. doi: 10.1016/j.pdpdt.2021.102657. Epub 2021 Nov 27. PMID: 34848378.
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Photodiagnosis Photodyn Ther. 2021 Nov 27;37:102657. doi: 10.1016/j.pdpdt.2021.102657. Epub 2021 Nov 27.

Association of 5-aminolevulinic acid with intraoperative hypotension in malignant glioma surgery.

Photodiagnosis and photodynamic therapy

Shumpei Morisawa, Kohei Jobu, Tomoaki Ishida, Kei Kawada, Hitoshi Fukuda, Yu Kawanishi, Taku Nakayama, Shinkuro Yamamoto, Naohisa Tamura, Mitsuhiro Takemura, Nao Kagimoto, Tsuyoshi Ohta, Noritaka Masahira, Hideo Fukuhara, Shun-Ichiro Ogura, Tetsuya Ueba, Keiji Inoue, Mitsuhiko Miyamura

Affiliations

  1. Department of Pharmacy, Kochi Medical School Hospital, 185-1, Kohasu, Oko town, Nankoku, Kochi, Japan; Graduate School of Integrated Arts and Sciences Kochi University, 185-1, Kohasu, Oko town, Nankoku, Kochi, Japan. Electronic address: [email protected].
  2. Department of Pharmacy, Kochi Medical School Hospital, 185-1, Kohasu, Oko town, Nankoku, Kochi, Japan.
  3. Department of Pharmacy, Kochi Medical School Hospital, 185-1, Kohasu, Oko town, Nankoku, Kochi, Japan; Graduate School of Integrated Arts and Sciences Kochi University, 185-1, Kohasu, Oko town, Nankoku, Kochi, Japan.
  4. Department of Neurosurgery, Kochi Medical School, Kochi University, 185-1, Kohasu, Oko town, Nankoku, Kochi, Japan.
  5. Center for Photodynamic Medicine, Kochi Medical School, 185-1, Kohasu, Oko town, Nankoku, Kochi, Japan.
  6. Department of Urology, Kochi Medical School, 185-1, Kohasu, Oko town, Nankoku, Kochi, Japan.
  7. Department of Neurosurgery, National Cerebral and Cardiovascular Center Hospital, 6-1 Kishibe Shimmachi, Suita Osaka, Japan.
  8. Department of Neurosurgery, Kochi Health Sciences Center, 2125-1, Ike, Kochi, Kochi, Japan.
  9. Center for Photodynamic Medicine, Kochi Medical School, 185-1, Kohasu, Oko town, Nankoku, Kochi, Japan; Department of Urology, Kochi Medical School, 185-1, Kohasu, Oko town, Nankoku, Kochi, Japan.
  10. Center for Photodynamic Medicine, Kochi Medical School, 185-1, Kohasu, Oko town, Nankoku, Kochi, Japan; School of Life Science and Technology, Tokyo Institute of Technology, 4259 B47, Nagatsuta-cho, Midori-ku, Yokohama, Kanagawa, Japan.

PMID: 34848378 DOI: 10.1016/j.pdpdt.2021.102657

Abstract

BACKGROUND: Use of 5-aminolevulinic acid for photodynamic malignant tumor diagnosis reportedly causes intraoperative hypotension (systolic blood pressure < 70 mmHg) during urologic surgery. However, its association with intraoperative hypotension in malignant glioma surgery and underlying mechanisms has not yet been elucidated.. This study aimed to investigate whether 5-aminolevulinic acid administration is associated with intraoperative hypotension in malignant glioma surgery and explore the mechanisms of 5-aminolevulinic acid-induced hypotension in vitro.

METHODS: In this retrospective multicenter cohort study, we investigated intracellular nitric oxide as a candidate mediator of hypotension in response to 5-aminolevulinic acid in vitro in human umbilical vein endothelial cell cultures.

RESULTS: Of 142 patients, 94 underwent 5-aminolevulinic acid-guided surgery. Systolic blood pressure was significantly lower throughout surgery with 5-aminolevulinic acid administration. 5-Aminolevulinic acid administration was an independent risk factor for intraoperative hypotension according to multivariable logistic regression analysis (89% vs. 56%; odds ratio = 6.72, 95% confidence interval [2.05-22.1], P = 002). In subgroup analysis of the 5-aminolevulinic acid group, increasing age and use of renin-angiotensin system inhibitors had a synergistic effect with 5-aminolevulinic acid on decreased blood pressure. In the vascular endothelial cell culture study, 5-aminolevulinic acid induced a significant increase in intracellular nitric oxide generation.

CONCLUSIONS: 5-Aminolevulinic acid administration was associated with intraoperative hypotension in malignant glioma surgery, with increasing age and use of renin-angiotensin system inhibitors boosting the blood pressure-lowering effect of 5-aminolevulinic acid. According to in vitro results, the low blood pressure induced by 5-aminolevulinic acid may be mediated by a nitric oxide increase in vascular endothelial cells.

Copyright © 2021 Elsevier B.V. All rights reserved.

Keywords: 5-aminolevulinic acid; Intraoperative hypotension; Malignant glioma; Nitric oxide

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