title: Catecholamine release induces elevation in plasma lactate levels in patients undergoing adrenalectomy for pheochromocytoma.
abstract: OBJECTIVE
  To determine the relationship between preoperative catecholamine levels and intraoperative peak plasma lactate levels in patients who underwent adrenalectomy for pheochromocytoma.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Operating room in one university hospital.
  
  
  METHODS
  The records of 27 ASA physical status 1 and 2 patients who underwent adrenalectomy for pheochromocytoma were studied. Preoperative catecholamine levels and intraoperative plasma lactate levels were recorded.
  
  
  RESULTS
  Twenty cases had high lactate levels (>2 mmol/L). Preoperative urine epinephrine levels and urine metanephrine levels showed a moderate correlation with intraoperative peak plasma lactate levels (rs = 0.475 and rs = 0.499, respectively; Spearman's rank correlation test). Receiver operating characteristic (ROC) curve analysis for preoperative urine epinephrine levels showed good performance for prediction of high lactate levels [>2 mmol/L, area under the curve (AUC) =0.800], whereas ROC for preoperative urine norepinephrine levels showed no predictive performance for high lactate levels.
  
  
  CONCLUSIONS
  Catecholamine release caused by surgical manipulation may be a possible cause of intraoperative transient lactic acidosis, and it should be considered as a differential diagnosis of intraoperative lactic acidosis. Intraoperative peak plasma lactate level was correlated with preoperative epinephrine-releasing activity.
authors.affiliation: Department of Anesthesiology, Medical Hospital of Tokyo Medical and Dental University, Tokyo 113-8519, Japan.
authors.forename: Kunio
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Department of Anesthesiology, Medical Hospital of Tokyo Medical and Dental University, Tokyo 113-8519, Japan.
authors.forename: Sonomi
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8519, Japan. Electronic address: uchida.mane@tmd.ac.jp.
authors.forename: Tokujiro
authors.initials: T
authors.lastname: Uchida
authors.affiliation: Department of Critical Care Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8519, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nakazawa
authors.affiliation: Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8519, Japan.
authors.forename: Koshi
authors.initials: K
authors.lastname: Makita
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D004837:Epinephrine / Q000652:urine; D005260:Female; D006785:Hospitals, University; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000652:urine; D010673:Pheochromocytoma / Q000601:surgery*; D012189:Retrospective Studies
chemical_list: D019344:Lactic Acid; D009638:Norepinephrine; D004837:Epinephrine
keywords: Catecholamines; epinephrine; lactic acidosis; norepinephrine; pheochromocytoma; surgical resection