Hyperlactemia associated with secondary hepatocellular carcinoma resection in relation to circulation stability and quality of recovery: A case report

Table 4 Case report timeline

Item		Timeline
Preoperative	1	Ten months after diagnosis of sigmoid colon cancer, 4 months after postoperative chemotherapy for liver metastasis
	2	History of “cerebral infarction” for more than six months without special treatment
	3	Abdominal CT scan suggestive of liver metastasis
	4	The operation was performed under general anesthesia
Perioperative	5	Invasive blood pressure was monitored and arterial blood gas analysis was conducted
	6	BIS was monitored
	7	Induction of conventional anesthesia with tracheal intubation
	8	CVC after general anesthesia. Ultrasound-guided transversus abdominis block was performed
	9	Maintenance of anesthesia was performed using static inhalation compound general anesthesia
	10	The operation was performed using Pringle's method to block the hepatic metastases, and arterial blood gases were monitored dynamically intraoperatively. Hyperlactatemia was detected and treated aggressively with fluid replacement and other treatments. However, the patient's vital signs were stable
	11	The surgery was successfully completed
Postoperative	12	After the operation, the patient was transferred to the PACU. There was still hyperlactatemia detected. However, the patient's vital signs were stable
	13	Treatments such as temperature protection as well as arterial blood gas testing were implemented, and although hyperlactatemia was present, vital signs were stable and awakening was satisfactory. The patient returned to the ward after surgery
	14	The patient was discharged six days after surgery
	15	The patient was followed up two months after the operation

BIS: Bispectral index; CT: Computed tomography; CVC: Central venous catheter; PACU: Post-anesthesia care unit.