Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Serum lactate concentration and oxygen transport in the early postoperativeperiod after anesthesia with sevoflurane in patients with heart valves diseasesoperated with cardiopulmonary bypass

Authors: G.V. Yudin, M.M. Rybka, M.V. Lomakin, A.A. Goncharov

Company:
Bakoulev National Scientific and Practical Center for Cardiovascular Surgery, Ministry of Health of the Russia, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814- 6910-2017-14-1-15-20

UDC: 616.127.2:616-089.168.1:616-089.5:616.12-007.1:616.12-089.8-78

Link: Clinical Physiology of Blood Circulaiton. 2017; 14 (1): 15-20

Quote as: Yudin G.V., Rybka M.M., Lomakin M.V., Goncharov A.A. Serum lactate concentration and oxygen transport in the early postoperative period after anesthesia with sevoflurane in patients with heart valves diseases operated with cardiopulmonary bypass. Klinicheskaya Fiziologiya Krovoobrashcheniya (Clinical Physiology of Circulation, Russian journal). 2017; 14 (1): 15–20 (in Russ.).

Received / Accepted:  16.12.2016/16.12.2016

Full text:  

Abstract

Objective – to study the effects of sevoflurane on the state of the transport and consumption of oxygen, dynamics of lactatemia in postbypass, and early postoperative periods in patients with heart valves diseases operated on cardiopulmonary bypass.
Material and methods. The study is a prospective, randomized, controlled trial. It included 60 patients operated on for heart valves diseases, divided into two groups of 30 people depending on the type of anesthesia: group of total intravenous anesthesia based on propofol (TIA) and volatile sevoflurane anesthesia (VA). Patients were defined gas and acid-base
composition of arterial and venous blood, the concentration of serum lactate in post-perfusion period, admission to the intensive care unit, on the 3rd, 6th, 9th, 12th, 18th, 24th hours of the early postoperative period. With Swan–Ganz catheter measured of cardiac output with calculation of cardiac index, indexes of delivery, consumption and extraction of oxygen in
the postbypass period, admission to the intensive care unit, on the 6th, 12th, 18th, 24th hour early postoperative period.
Results. The value of cardiac index was constant throughout the observation period and did not differ significantly between
the groups: in group TIA 3.0±0.2 l/min/m2 and in group VA 3.1±0.1 l/min/m2 (p>0.05). Hyperlactatemia was observed in all patients and reached maximum values at the 6th hour, 8.6±3.5 mmol/l (VA) and 11.8±4.8 mmol/l (TIA), at the 12th hour, 7.3±3.7 mmol/l (VA) and 10.0±3.7 mmol/l (TIA), with the peak up to 9 hours of observation, 9.9±4.1 mmol/l (VA) and 12.7±4.9 mmol/l (TIA). In group VA its intensity was reliability lower (p<0.05). Correlation between the concentration of
serum lactate with cardiac index, indices of deliver and consumption of oxygen and rate of oxygen extraction was absent (p>0.05).
Conclusion. It was found that the concentration of serum lactate is not dependent on oxygen transport and its tissular utilization, and the use of sevoflurane reduces the severity of hyperlactatemia in early postoperative period in patients with heart valves diseases, operated on cardiopulmonary bypass.

References

1. Laine G.A., Hu B.Y., Wang S., Solis R.T., Reul G.J.
Isolated high lactate or low central venous oxygen saturation
after cardiac surgery and association with outcome.
J. Cardiothorac. Vasc. Anesth. 2013; 27 (6): 1271–6.
2. Lopez-Delgado J.C., Estive F., Javierre C., Torrado H.,
Rodriguez-Castro D., Carrio M.L. et al. Evaluation of
serial arterial lactate levels as a predictor of hospital and
long-term mortality in patients after cardiac surgery.
J. Cardiothorac. Vasc. Anesth. 2015; 29 (6): 1441–53.
3. Brian F.M., Dellinger M., Phillip R. Lactate as a hemodynamic
marker in critical ill. Curr. Opin. Crit. Care.
2012; 8 (3): 267–72.
4. Trzeciak R., Dellinger P., Chansky M.E., Arnold R.C.,
Schorr C., Milcarek B. et al. Serum lactate as a predictor
of mortality in patients with infection. Intens. Care
Med. 2007; 33 (6): 970–7.
5. Dedichen H.H., Hisdal J., Aadahi P., Nordhaug D.,
Olsen P.O., Kirkeby-Garstad I. Elevated arterial lactate
concentrations early after coronary artery bypass grafting
are associated with increased anaerobic metabolism
in skeletal muscle. J. Cardiothorac. Vasc. Anesth. 2015;
29 (2): 367–73.
6. Jansen T.C., van Bommel J., Bakker J. Blood lactate
monitoring in critically ill patients: a systematic health
technology assessment. Crit. Care Med. 2009; 37 (10):
2827–39.
7. Ballester M., Julio L., Garcia-de-la-Asuncion J.,
Perez-Griera J., Tebar E., Martinez-Leon J. et al.
Myocardial oxidative stress protection by sevoflurane
vs. propofol: a randomised controlled study in patients
undergoing off-pump coronary artery bypass graft surgery.
Eur. J. Anesthesiol. 2011; 28 (12): 874–81.
8. Hemmerling T., Olivier J.-F., Le N., Prieto I., Bracco D.
Myocardial protection by isoflurane vs. sevoflurane in
ultra-fast-track anaesthesia for off-pump aortocoronary
bypass grafting. Eur. J. Anesthesiol. 2008; 25 (3): 230–6.
9. Lemoine S., Tritapepe L., Hanouz J.L., Puddu P.E. The
mechanisms of cardio-protective effects of desflurane
and sevoflurane at the time of reperfusion: anaesthetic
post-conditioning potentially translatable to humans?
Br. J. Anaesth. 2016; 116 (4): 456–75.
10. Nigro Neto C., Landoni G., Cassara L., De Simone F.,
Zangrillo A., Tardelli M.A. Use of volatile anesthetics
during cardiopulmonary bypass: a systematic review of
adverse events. J. Cardiothorac. Vasc. Anesth. 2014;
28 (1): 84–9.
11. Лобачева Г.В., Рыбка М.М., Юдин Г.В. Нитровазо-
регуляторы во время операции на сердце с искусст-
венным кровообращением. Нитроглицерин или
нитропруссид натрия? Вестник анестезиологии и
реаниматологии. 2011; 6: 48–52.

 If you found mistakes, select text and press Alt+A