Association Between Preoperative 5-Aminolevulinic Acid Administration Timing and Perioperative Hypotension

Photodynamic diagnosis-assisted transurethral resection of bladder tumors with oral 5-aminolevulinic acid administration improves tumor visibility but results in perioperative hypotension. In 2024, the recommended timing of 5-aminolevulinic acid administration was revised to enable oral intake 2-8 h preoperatively, thereby making it easier to adjust the timing of drug administration and surgery. This study aimed to investigate the association between the interval from 5-aminolevulinic acid administration to the start of surgery and perioperative blood pressure.

We retrospectively analyzed 112 consecutive patients who underwent photodynamic diagnosis-assisted transurethral resection of bladder tumors from July 2022 to June 2024. Patients were categorized based on the time between oral 5-aminolevulinic acid administration and spinal or general anesthesia induction into the control (< 4 h) and extended time (≥ 4 h) groups. The perioperative blood pressure and severity of hypotension were compared between the two groups.

The extended time group comprised fewer cases of moderate to severe hypotension than the control group (38% and 61%, respectively; p = 0.039). Blood pressure was significantly higher at several time points intraoperatively in the extended time group. Further, the extended time group required fewer doses of vasopressor agents (p = 0.025).

An interval of more than 4 h from oral 5-aminolevulinic acid intake to anesthesia administration may reduce the risk of perioperative hypotension during photodynamic diagnosis-assisted transurethral resection of bladder tumors.