Effects of intraoperative adrenergic administration on postoperative hyperlactatemia in open colon surgery: an observational study.
Adrenergic agents
Ephedrine
Hyperlactatemia
Lactate
Phenylephrine
Journal
Brazilian journal of anesthesiology (Elsevier)
ISSN: 2352-2291
Titre abrégé: Braz J Anesthesiol
Pays: Brazil
ID NLM: 101624623
Informations de publication
Date de publication:
Historique:
received:
22
05
2019
revised:
21
08
2020
accepted:
09
09
2020
entrez:
13
3
2021
pubmed:
14
3
2021
medline:
26
10
2021
Statut:
ppublish
Résumé
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. To evaluate whether the use of intraoperative adrenergic agents is associated with the occurrence of PO-HL. 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 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 (ScvO 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.
Sections du résumé
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
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 (ScvO
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.
Identifiants
pubmed: 33712255
pii: S0104-0014(20)30214-1
doi: 10.1016/j.bjane.2020.09.011
pmc: PMC9373707
pii:
doi:
Substances chimiques
Adrenergic Agents
0
Phenylephrine
1WS297W6MV
Ephedrine
GN83C131XS
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
58-64Informations de copyright
Copyright © 2020 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.
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