Tohoku J. Exp. Med., 2012 Nov, 228(3)

Intraoperative Plasma Lactate as an Early Indicator of Major Postoperative Events in Pediatric Cardiac Patients

SEONG-JOO PARK,¹ HEE-SOO KIM,² HYO-JIN BYON,⁴ CHONG-SUNG KIM,² IL-YOUNG CHEONG³ and JIN-TAE KIM²

¹Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gyeonggi-Do, Korea
²Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
³Department of Anesthesiology and Pain Medicine,Kangwon National University Hospital, Gangwon-Do, Korea
⁴Department of Anesthesiology and Pain Medicine,Inha National University Hospital, Incheon, Korea

Hyperlactatemia and unmeasured anions (UMA) have been suggested to be useful predictors of outcomes after pediatric cardiac surgery in the ICU. However, if we detect high-risk patient in the operating room, we could practice early intervention to decrease mortality and morbidity. The purpose of this study was to determine whether the intraoperative lactate or UMA levels can predict adverse outcomes in pediatric cardiac patients with undergoing cardiopulmonary bypass (CPB). We studied 102 patients with congenital heart disease. Arterial blood samples were obtained after inducing anesthesia, 5 min after weaning from CPB and after chest closure. Major adverse events (MAEs) were defined as cardiac compression, re-sternotomy due to hemodynamic instability, extra-corporeal membrane oxygenator support, creatinine levels greater than 2 mg/dL, or death. Patients were divided into MAE group (8 patients, 7.8%) and non-MAE group. Six patients with MAEs died. Importantly, the lactate levels (mmol/L) at weaning from CPB (4.19 vs 2.1; MAE group vs non-MAE group), chest closure (5.76 vs 2.39; MAE group vs non-MAE group) and the intraoperative increases in lactate levels were significantly higher in the MAE group than in the non-MAE group. However, there was no significant difference in the UMA levels or their changes between the groups. The increase in the lactate level from CPB weaning to chest closure was the best predictor of MAEs (AUC: 0.810). In conclusion, the intraoperative plasma lactate levels were more closely associated with MAEs, and they are more useful for predicting the outcome of pediatric cardiac patients than the UMA levels.

keywords —— congenital heart disease; lactate; perioperative care; predictor of outcome; unmeasured anions

© 2012 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2012, 228, 239-245

Correspondence: Jin-Tae Kim, M.D. Ph.D., Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, #101 daehak-Ro, Chongro-Gu, Seoul, Korea.

e-mail: kimjintae73@dreamwiz.com