CC BY 4.0 · J Neuroanaesth Crit Care 2023; 10(02): 094-101
DOI: 10.1055/s-0043-1767828
Original Article

Perioperative Outcomes of Hyperlactatemia during Craniotomy: A Systematic Review and Meta-Analysis of 1,832 Patients

1   Anaesthesia Department, Beaumont Hospital, Dublin, Ireland
,
2   Faculty of Medicine, Fayoum University, Fayoum, Egypt
,
3   Faculty of Medicine, Zagazig University, Zagazig, Egypt
,
4   Faculty of Medicine, Kafrelsheikh University, Kafr El-Sheikh, Egypt
,
Ahmed S. Aljabali
5   Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
,
Hazem S. Ghaith
6   Faculty of Medicine, Al-Azhar University, Cairo, Egypt
› Author Affiliations

Abstract

Background Hyperlactatemia, is common in patients undergoing neurosurgical procedures. Several studies have identified potential risk factors for developing hyperlactatemia in neurosurgical patients, including body mass index, surgery duration, tumour volume, and certain drugs such as volatile anesthetic agents and corticosteroids. This systematic review and meta-analysis examined the evidence of the association between perioperative lactate levels in patients undergoing brain surgery and postoperative morbidity and mortality.

Methods Using PubMed, Scopus, Web of Science, Embase, CINAHL, Medline, Google Scholar, and the Cochrane Central Register of Controlled Trials databases, a systematic literature search was conducted for studies examining the association between perioperative hyperlactatemia and postoperative outcomes in patients undergoing brain surgery. Two authors independently evaluated the full-text papers for eligibility, and then data extraction and meta-analyses of similar studies were conducted (using a random effect model for each outcome measure). The Newcastle Ottawa Scale was used to evaluate the risk of bias (NOS scale).

Results Seven observational studies were included, and a total of 1,832 patients were assessed in the systematic review and meta-analysis. The quality of the included studies ranged from poor to high quality according to the NOS quality assessment tool. Meta-analysis results revealed no significant association between perioperative hyperlactatemia and postoperative new neurological deficits (five studies: odds ratio [OR] = 0.97, 95% confidence interval [CI] [0.50–1.87], p = 0.92; heterogeneity: I 2 = 38%, p = 0.18). Similarly, perioperative hyperlactatemia was neither significantly associated with increased 30-day postoperative mortality (two studies; OR = 0.20, 95% CI [0.02–2.00], p = 0.17; heterogeneity: I 2 = 0%, p = 0.59) nor 6 months survival rate (three studies; OR = 1.05, 95% CI [0.75–1.47], p = 0.79; heterogeneity: I 2 = 0%, p = 0.51). Moreover, there was no difference in the length of hospital stay between the two groups (four studies: mean difference = –0.85, 95% CI [–1.73 to 0.03], p = 0.06). Pooled studies were not homogenous (I 2 = 68%, p = 0.03).

Conclusion Perioperative hyperlactatemia is benign in neurosurgical patients and is not associated with significant postoperative outcomes, such as developing new postoperative neurological deficit, 30-day mortality, 6-month survival, or prolonged hospital stay.

Supplementary Material



Publication History

Article published online:
14 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW. Etiology and therapeutic approach to elevated lactate levels. Mayo Clin Proc 2013; 88 (10) 1127-1140
  • 2 Mizock BA. Significance of hyperlactatemia without acidosis during hypermetabolic stress. Crit Care Med 1997; 25 (11) 1780-1781
  • 3 Redant S, Hussein H, Mugisha A. et al. Differentiating hyperlactatemia type A from type B: how does the lactate/pyruvate ratio help?. J Transl Int Med 2019; 7 (02) 43-45
  • 4 de Smalen PP, van Ark TJ, Stolker RJ, Vincent AJPE, Klimek M. Hyperlactatemia after intracranial tumor surgery does not affect 6-month survival: a retrospective case series. J Neurosurg Anesthesiol 2020; 32 (01) 48-56
  • 5 Kohli-Seth R, Mukkera SR, Leibowitz AB. et al. Frequency and outcomes of hyperlactatemia after neurosurgery. ICU Dir 2012; 2 (06) 211-214
  • 6 Romano D, Deiner S, Cherukuri A. et al. Clinical impact of intraoperative hyperlactatemia during craniotomy. PLoS One 2019; 14 (10) e0224016
  • 7 Allen M. Lactate and acid base as a hemodynamic monitor and markers of cellular perfusion. Pediatr Crit Care Med 2011; 12 (4, suppl): S43-S49
  • 8 Mariappan R, Venkatraghavan L, Vertanian A. et al. Serum lactate as a potential biomarker of malignancy in primary adult brain tumours. J Clin Neurosci 2015; 22 (01) 144-148
  • 9 Bharadwaj S, Venkatraghavan L, Mariappan R. et al. Serum lactate as a potential biomarker of non-glial brain tumors. J Clin Neurosci 2015; 22 (10) 1625-1627
  • 10 Xu W, Mellergård P, Ungerstedt U, Nordström CH. Local changes in cerebral energy metabolism due to brain retraction during routine neurosurgical procedures. Acta Neurochir (Wien) 2002; 144 (07) 679-683
  • 11 Yoshikawa H, Nishibe S, Sakai D. et al. Early postoperative hyperlactatemia in elective neurosurgical patients: a retrospective study. Journal of Saitama Medical University 2018; 45 (01) 1-11
  • 12 Garavaglia M, Mak T, Cusimano MD. et al. Body mass index as a risk factor for increased serum lactate during craniotomy. Minerva Anestesiol 2013; 79 (10) 1132-1139
  • 13 Horn T, Klein J. Lactate levels in the brain are elevated upon exposure to volatile anesthetics: a microdialysis study. Neurochem Int 2010; 57 (08) 940-947
  • 14 Rozet I, Tontisirin N, Muangman S. et al. Effect of equiosmolar solutions of mannitol versus hypertonic saline on intraoperative brain relaxation and electrolyte balance. Anesthesiology 2007; 107 (05) 697-704
  • 15 Cata JP, Bhavsar S, Hagan KB. et al. Intraoperative serum lactate is not a predictor of survival after glioblastoma surgery. J Clin Neurosci 2017; 43: 224-228
  • 16 Mascia L, Mazzeo AT. Is inadequate tissue perfusion a relevant issue during neurosurgery?. Minerva Anestesiol 2013; 79 (10) 1105-1107
  • 17 Fazili RJ, Naqash IN, Ali Z, Bhat AR, Mir AH, Mir SA. Correlation between intraoperative serum lactate and new-onset postoperative neurodeficits in patients undergoing elective craniotomies. Anesth Essays Res 2021; 15 (03) 296-300
  • 18 Brallier JW, Dalal PJ, McCormick PJ, Lin H-M, Deiner SG. Elevated intraoperative serum lactate during craniotomy is associated with new neurological deficit and longer length of stay. J Neurosurg Anesthesiol 2017; 29 (04) 388-392
  • 19 Veličković J, Palibrk I, Miličić B. et al. The association of early postoperative lactate levels with morbidity after elective major abdominal surgery. Bosn J Basic Med Sci 2019; 19 (01) 72-80
  • 20 Garavaglia M, Timothy MH, Cusimano M. et al. Hyperlactatemia during craniotomy: evidence of muscle hypoperfusion? Conference Abstract. Can J Anaesth 2013; 60 (01) S68
  • 21 Adeva-Andany M, López-Ojén M, Funcasta-Calderón R. et al. Comprehensive review on lactate metabolism in human health. Mitochondrion 2014; 17: 76-100
  • 22 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372 (71) n71
  • 23 Sidwell K. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. J Hell Stud 1993; 113: 198-199
  • 24 Ogbu OC, Murphy DJ, Martin GS. How to avoid fluid overload. Curr Opin Crit Care 2015; 21 (04) 315-321
  • 25 Millet A, Cuisinier A, Bouzat P. et al. Hypertonic sodium lactate reverses brain oxygenation and metabolism dysfunction after traumatic brain injury. Br J Anaesth 2018; 120 (06) 1295-1303
  • 26 Hollyer TR, Bordoni L, Kousholt BS, van Luijk J, Ritskes-Hoitinga M, Østergaard L. The evidence for the physiological effects of lactate on the cerebral microcirculation: a systematic review. J Neurochem 2019; 148 (06) 712-730
  • 27 Rice AC, Zsoldos R, Chen T. et al. Lactate administration attenuates cognitive deficits following traumatic brain injury. Brain Res 2002; 928 (1-2): 156-159