Lactate is correlated with the indocyanine green elimination rate in liver resection for cirrhotic patients.
The role of lactate in liver ischemia-reperfusion injury in cirrhosis has not been clarified. Fifty patients with hepatocellular carcinoma who underwent partial liver resection under Pringle's maneuver were included in this study. We performed the indocyanine green clearance test before the operation and three times during the surgery to calculate its elimination rate. Blood lactate and base excess were measured at the corresponding times. Systolic and diastolic systemic arterial pressure, heart rate, cardiac index, and esophageal temperature were monitored. Aminotransferase levels were recorded the day before the operation, 1 h after the operation, and on the first and third postoperative days. We calculated the increase or decrease in lactate levels during the preischemic, ischemic, and postischemic phases, and examined the correlation between these results and the changes in indocyanine green elimination rate and some clinical factors. The lactate levels increased before reperfusion and began to decrease after reperfusion. The lactate increase and decrease during the ischemic and postischemic phases correlated with the change in indocyanine green elimination rate (P < 0.0001 and P = 0.02 for the respective phases). The lactate increase during the preischemic phase correlated with the duration of the preischemic phase (P < 0.0001). In cirrhotic patients who undergo liver resection with Pringle's maneuver and who do not show postoperative liver failure, the blood lactate profile might be a reliable indicator of liver metabolic capacity during surgery.


CONCLUSIONS
In cirrhotic patients who underwent liver resection with Pringle's maneuver, the lactate increase and decrease during the ischemic and postischemic phases correlated with the change in the indocyanine green elimination rate. The blood lactate profile might be a reliable indicator of liver metabolic capacity during surgery.
Department of Anesthesiology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
R
R
Orii
Y
Y
Sugawara
M
M
Hayashida
K
K
Uchida
Y
Y
Yamada
T
T
Takayama
M
M
Makuuchi
K
K
Hanaoka
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide / Q000097:blood; D004396:Coloring Agents / Q000493:pharmacokinetics*; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007208:Indocyanine Green / Q000493:pharmacokinetics*; D019344:Lactic Acid / Q000097:blood*; D008099:Liver / Q000601:surgery*; D008102:Liver Circulation / Q000502:physiology; D008103:Liver Cirrhosis / Q000601:surgery*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis
D004396:Coloring Agents; D002245:Carbon Dioxide; D019344:Lactic Acid; D007208:Indocyanine Green