Meng Y, Pei HS, Yu JJ. Hyperlactemia associated with secondary hepatocellular carcinoma resection in relation to circulation stability and quality of recovery: A case report. World J Clin Cases 2023; 11(8): 1869-1877 [PMID: 36970009 DOI: 10.12998/wjcc.v11.i8.1869]
Corresponding Author of This Article
Huan-Shuang Pei, MM, Associate Professor, Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, No. 12 Jian-Kang Road, Chang'an District, Shijiazhuang 050000, Hebei Province, China. wxhmz99999@163.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 16, 2023; 11(8): 1869-1877 Published online Mar 16, 2023. doi: 10.12998/wjcc.v11.i8.1869
Hyperlactemia associated with secondary hepatocellular carcinoma resection in relation to circulation stability and quality of recovery: A case report
Yu Meng, Huan-Shuang Pei, Jia-Jia Yu
Yu Meng, Huan-Shuang Pei, Jia-Jia Yu, Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
Author contributions: Meng Y and Yu JJ participated in the anesthesia management of the present case, and both were the major contributors to this manuscript; Pei HS helped revise the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: The subject profiled in this case report provided their written informed consent for the anonymized publication of their case report findings and all accompanying images.
Conflict-of-interest statement: The authors have no actual or potential conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Huan-Shuang Pei, MM, Associate Professor, Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, No. 12 Jian-Kang Road, Chang'an District, Shijiazhuang 050000, Hebei Province, China. wxhmz99999@163.com
Received: January 7, 2023 Peer-review started: January 7, 2023 First decision: January 30, 2023 Revised: February 7, 2023 Accepted: February 21, 2023 Article in press: February 21, 2023 Published online: March 16, 2023
Abstract
BACKGROUND
Intraoperative hyperlactatemia often affects circulatory stability, vital organ function, and postoperative recovery, poses a serious prognostic risk, and requires considerable attention from anesthesiologists. Here, we describe a case of hyperlactatemia during the postoperative resection of liver metastases after chemotherapy for sigmoid colon cancer. This did not affect the patient's circulatory stability or quality of awakening, which is rarely reported in clinical practice. We present our management experience with the aim of providing a reference for future studies and clinical practice.
CASE SUMMARY
A 70-year-old female patient was diagnosed with postoperative liver metastasis following chemotherapy for sigmoid colon cancer. Laparoscopic right hemicolectomy and cholecystectomy under general anesthesia were required. Metabolic disorders, primarily hyperlactatemia, often occur intraoperatively. After treatment, other indices quickly returned to normal, lactate levels decreased slowly, and hyperlactatemia persisted during the awakening period. However, this did not affect the patient's circulatory stability or awakening quality. This condition has rarely been clinically reported. Therefore, we report our management experience in order to guide clinical practice in this regard. Hyperlactatemia did not affect circulatory stability or the quality of awakening. We considered that active intraoperative rehydration avoided serious harm to the organism caused by hyperlactatemia due to insufficient tissue perfusion, while hyperlactatemia caused by decreased lactate clearance due to impaired liver function associated with surgical resection had a mild effect on the function of important organs.
CONCLUSION
Active intraoperative rehydration avoided serious harm to the organism caused by hyperlactatemia. Strengthening body temperature protection could improve lactate circulation.
Core Tip: Intraoperative hyperlactatemia often affects circulatory stability and vital organ function, posing serious prognostic risks. Cases wherein circulatory stability and recovery quality are unaffected are rarely reported. We consider that aggressive intraoperative rehydration avoids serious harm to the organism caused by hyperlactatemia due to insufficient tissue perfusion. Enhanced thermoprotection also improved lactate circulation. There may be individual differences in metabolism and lactate may have a slow clearance profile. The impact on circulation and quality of awakening was mild. Awakening extubation can be performed to reduce the duration of mechanical ventilation and risk of delayed extubation, and to shorten the hospital stay.
