Correlation Between Intraoperative Serum Lactate & New-Onset Postoperative Neurodeficits In Patients Undergoing Elective Craniotomies - A Prospective Observational Study

Abstract

BACKGROUND: Elevated lactate levels in neurosurgical patients are seen in brain tumours, traumatic brain-injury, brain infarction and subarachnoid haemorrhage. Hyperlactatemia during craniotomy may be caused by hypotension due to multiple factors. Recently intraoperative hyperlactatemia has been associated with fresh-onset neurodeficits.

 OBJECTIVE:

1. To study the prevalence of hyperlactatemia in patients undergoing craniotomy.

2. To study the relationship between intraoperative hyperlactatemia and development of new postoperative neurodeficit.

STUDY DESIGN: 86 patients undergoing elective craniotomy for neurosurgical indications were included in this prospective, observational study.

PARTICIPANTS: 86 patients, ASA class 1-3 undergoing elective craniotomy.

METHODS: Baseline, intraoperative and postoperative (upto 12 hours) lactate levels were noted. Neurological examination to detect new-onset neurodeficits was done at intervals upto 72 hours postoperatively. Lactate levels were compared between patients who developed neurodeficits and those who did not develop neurodeficits postoperatively.

RESULTS: The prevalence of intraoperative hyperlactatemia was found to be 52.3% and that of fresh-onset postoperative neurodeficits was 31.4%. The relationship between the two was statistically insignificant (p-value>0.05).

CONCLUSION: The intraoperative hyperlactatemia is not correlated with the development of fresh-onset postoperative neurodeficit.

IMPLICATIONS: There may be no relationship between the intraoperative lactate levels and fresh-onset postoperative neurodeficits. Multifactorial reasons may be responsible for increased lactate levels which need to be identified by further research.