November 29, 2025
Background: Pheochromocytomas and paragangliomas are uncommon neuroendocrine tumors that present significant anesthetic challenges, particularly in maintaining hemodynamic stability. The Hypotension Prediction Index (HPI) can be used for intraoperative hemodynamic monitoring and management.
Case Presentation: A 46-year-old woman with a paraganglioma underwent laparoscopic retroperitoneal tumor resection using HPI-guided hemodynamic monitoring. Mean arterial pressure (MAP) and HPI demonstrated an inverse relationship during anesthesia induction and throughout the procedure. MAP increased from approximately 90 mmHg to 120-150 mmHg during tracheal intubation and tumor manipulation, requiring intermittent phentolamine administration to control hypertensive episodes. Following ligation of the tumor’s feeding vessels, MAP declined, accompanied by a corresponding increase in HPI values. Intraoperative hypotension was managed according to HPI-guided protocols, resulting in a very low time-weighted average MAP below 65 mmHg (0.007 mmHg). Cross-correlation analysis showed that the minimum correlation between HPI and MAP occurred at a time lag of zero, indicating no delay between the two measurements. However, HPI provided alerts 3 to 17 minutes before MAP decreased below 65 mmHg.
Conclusions: This case demonstrates the potential utility of HPI-guided monitoring for minimizing intraoperative hypotension during paraganglioma resection. The findings also suggest that the absence of a time delay between HPI and MAP in cross-correlation analysis does not necessarily indicate poor predictive performance. Further studies are needed to evaluate the predictive accuracy and clinical utility of HPI during surgery for pheochromocytomas and paragangliomas.
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