Clinical impact of intraoperative hyperlactatemia during craniotomy

Autoři: Diana Romano aff001;  Stacie Deiner aff001;  Anjali Cherukuri aff004;  Bernard Boateng aff005;  Raj Shrivastava aff002;  J. Mocco aff002;  Constantinos Hadjipanayis aff002;  Raymund Yong aff002;  Christopher Kellner aff002;  Kurt Yaeger aff002;  Hung-Mo Lin aff006;  Jess Brallier aff007
Působiště autorů: Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America aff001;  Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America aff002;  Department of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America aff003;  University of Central Florida College of Medicine, Orlando, FL, United States of America aff004;  Alabama College of Osteopathic Medicine, Dothan, AL, United States of America aff005;  Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America aff006;  Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America aff007
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224016



Patients often develop markedly elevated serum lactate levels during craniotomy although the reason for this is not entirely understood. Elevated lactate levels have been associated with poor outcomes in critically ill septic shock patients, as well as patients undergoing abdominal and cardiac surgeries. We investigated whether elevated lactate in craniotomy patients is associated with neurologic complications (new neurological deficits) as well as systemic complications.


We performed a cohort study of elective craniotomy patients. Demographic and intraoperative data were collected, as well as three timed intraoperative arterial lactate values. Additional lactate, creatinine and troponin values were collected immediately postoperatively as well as 12 and 24 hours postoperatively. Assessment for neurologic deficit was performed at 6 hours and 2 weeks postoperatively. Hospital length-of-stay and 30-day mortality were collected.


Interim analysis of 81 patients showed that no patient had postoperative myocardial infarction, renal failure, or mortality within 30 days of surgery. There was no difference in the incidence of new neurologic deficit in patients with or without elevated lactate (10/26, 38.5% vs. 15/55 27.3%, p = 0.31). Median length of stay was significantly longer in patients with elevated lactate (6.5 vs. 3 days, p = 0.003). Study enrollment was terminated early due to futility (futility index 0.16).


Elevated intraoperative serum lactate was not associated with new postoperative neurologic deficits, other end organ events, or 30 day mortality. Serum lactate was related to longer hospital stay.

Klíčová slova:

Blood – Brain damage – Hospitals – Lesions – Surgical and invasive medical procedures – Vascular surgery – Craniotomy – Renal failure


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