Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.09.011
Brazilian Journal of Anesthesiology
Clinical Research

Effects of intraoperative adrenergic administration on postoperative hyperlactatemia in open colon surgery: an observational study

Eduardo Tobar, Rodrigo Cornejo, Jaime Godoy, Mario Abedrapo, Gabriel Cavada, Daniel Tobar

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Abstract

Background
Postoperative Hyperlactatemia (PO-HL) is a frequent condition associated with poor prognosis. In recent years, there has been growing evidence that adrenergic stimulation may contribute to increased lactate levels. The use of adrenergic agonists for the control of intraoperative hypotension is frequent, and its impact on the development of PO-HL is unknown.

Objective
To evaluate whether the use of intraoperative adrenergic agents is associated with the occurrence of PO-HL.

Methods
This was a prospective observational study. The inclusion criteria were undergoing elective open colon surgery, being ≥60 years old and signing informed consent. The exclusion criteria were cognitive impairment, unplanned surgery, and anticipated need for postoperative mechanical ventilation. Baseline and intraoperative variables were collected, and arterial lactate data were collected at baseline and every 6 hours postoperatively for 24 hours. Hyperlactatemia was defined as lactate >2.1 mEq.L-1.

Results
We studied 28 patients, 61% of whom developed hyperlactatemia. The variables associated with PO-HL in the univariate analysis were anesthetic time, the total dose of intraoperative ephedrine, and lower intraoperative central venous oxygen saturation (ScvO2). Multivariate analysis confirmed the association between the use of ephedrine (p = 0.004), intraoperative hypotension (p = 0.026), and use of phenylephrine (p = 0.001) with PO-HL.

Conclusions
The use of intraoperative ephedrine, phenylephrine and intraoperative hypotension were independently associated with the development of PO-HL. This finding should lead to new studies in this field, as well as a judicious interpretation of the finding of a postoperative increase in lactate levels.

Keywords

Lactate;  Ephedrine;  Adrenergic agents;  Hyperlactatemia;  Phenylephrine
600842310e8825b43b345c1a rba Articles
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Rev. Bras. Anestesiol.

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