Comparison of oral 5-aminolevulinic acid-induced hypotension between general and spinal anesthesia during photodynamic diagnosis-assisted transurethral resection of bladder tumor for non-muscle invasive bladder cancer.

BACKGROUND

Transurethral resection of bladder tumor (TURBT) using photodynamic diagnosis (PDD) with oral 5-aminolevulinic acid hydrochloride (5-ALA) with non-muscle-invasive bladder cancer (NMIBC) frequently results in hypotension being reported as a common serious side effect. Previous papers have reported that oral 5-ALA-induced hypotension is associated with both general and spinal anesthesia However, no study has analyzed oral 5-ALA-induced hypotension by separately evaluating each anesthesia type.

METHODS

We retrospectively compared the systolic blood pressure (SBP) values with the frequency of vasopressor uses between general anesthesia group of 295 patients and spinal anesthesia group of 139 patients. Multivariable logistic regression analysis between general anesthesia and spinal anesthesia groups was performed for hypotensive patients with SBP less than 80 mmHg using vasopressors.

RESULTS

A total of 434 patients who underwent PDD‑TURBT were included in the final analysis. The incidence of hypotension and the incidence of severe hypotension (among cases of hypotension) were determined for the general anesthesia and spinal anesthesia groups. The mean intraoperative lowest SBP was 73.1 mmHg in the general anesthesia group and 95.2 mmHg in the spinal anesthesia group (p < 0.001). In general anesthesia, older age, shorter 5‑ALA exposure, and lower initial SBP at the beginning of anesthesia predicted hypotension, whereas in spinal anesthesia, male sex and lower initial SBP at the beginning of anesthesia were significant predictors by multivariate analyses.

CONCLUSIONS

The risk factors for oral 5‑ALA‑induced hypotension differ between the general anesthesia and spinal anesthesia groups, which is highlighting the importance of managing blood pressure while considering the specific risks associated with each type of anesthesia.