埼玉医科大学雑誌

埼玉医科大学雑誌第45巻第1号 (2018年8月) 1-11頁◇論文(図表を含む全文)は，PDFファイルとなっています．

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原著
Early postoperative hyperlactatemia in elective neurosurgical patients: A retrospective study

Hiroaki Yoshikawa^1)＊, Shinichi Nishibe²⁾, Daisuke Sakai³⁾, Hirokazu Imanishi⁴⁾, Seika Ohno¹⁾, Katsue Kobayashi⁵⁾, Akira Kitamura¹⁾,
1) Department of Anesthesiology, Saitama Medical University International Medical Center
2) Department of Anesthesiology, Tokyo Metropolitan Children’s Medical Center
3) Department of Anesthesiology, Chiba-Nishi General Hospital
4) Department of Anesthesiology, Tominaga Hospital
5) Division of Disability and Oral Health, Meikai University School of Dentistry

[Purpose] We occasionally encounter early postoperative hyperlactatemia during neurosurgery in the absence of hemodynamic instability or critical illness. We conducted a retrospective study to identify factors causing hyperlactatemia in elective neurosurgical patients and assessed the association between early postoperative hyperlactatemia and postoperative morbidity.
[Methods] The present study enrolled elective neurosurgical patients in whom an arterial blood gas analysis, including the measurement of lactate levels, had been performed at two-time points (i.e., after the induction of anesthesia and immediately before the surgery was completed). Early postoperative hyperlactatemia was defined as a lactate level of ≥ 2 mmol/L in arterial blood collected immediately before the completion of the surgery. Patients were divided into a high-lactate (HL) group, including those with early postoperative hyperlactatemia, and a normal-lactate (NL) group, including the remaining patients, and were compared. The following variables were retrieved from medical records: patient characteristics; perioperative vital signs; preoperative comorbidities; type of surgery; brain tumor pathology; size of brain tumor; preoperative comorbidities; duration of surgery; blood loss; PaO₂,PaCO₂, pH, and lactate; catecholamine use; length of stay in the ICU; mechanical ventilation requirement; and postoperative adverse events. Multiple logistic regression analysis was used to identify factors causing postoperative hyperlactatemia.
[Results] Two hundred and twenty-five patients were involved in this study. Early postoperative hyperlactatemia was observed in 49 of 225 (22%) patients. Brain tumor surgery, longer duration of surgery, preoperative hyperlactatemia, and larger blood loss volume were found to be more prevalent in the HL group than in the NL group, as per univariate analysis (P < 0.05). Risk factors for early postoperative hyperlactatemia were preoperative hyperlactatemia (odds ratio=27.83; 95% confidence interval=8.516-90.92, P=0.000) and brain tumor surgery (odds ratio=4.806; 95% confidence interval=1.006-21.67, P=0.041) in multiple regression analysis. Of the 225 patients, 89 patients underwent a craniotomy for the resection of a brain tumor. The sizes of the brain tumors in the HL group (1016 mm² [IQR: 545, 1951 mm²]) were significantly larger than those in the NL group (780 mm² [IQR: 322, 1107 mm²]) (P=0.02). Preoperative steroids and diuretics to reduce intracranial hypertension were more often prescribed for patients with high-grade tumors (P=0.01, P=0.07, respectively). Of the 49 patients in the HL group, 15 (31 %) stayed in the ICU for ≥ 2 days after surgery, whereas only 28 of 176 (16 %) patients in the NL group did (P < 0.05).
[Conclusion] Preoperative hyperlactatemia and brain tumor surgery are independent risk factors for early postoperative hyperlactatemia. Early postoperative hyperlactatemia is associated with a longer length of stay in the ICU. The role of early postoperative hyperlactatemia as a predictor of adverse postoperative complications in neurosurgical patients needs to be investigated further in future studies.

J Saitama Medical University 2018; 45(1): 1-11
(Received April 25, 2017 / Accepted February 15, 2018)

Keywords: hyperlactatemia, brain tumor, Warburg effect, neurosurgery

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(C) 2018 The Medical Society of Saitama Medical University