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ASSA13-08-12 Hyperlactatemia in Children with Congenital Heart Diseasesafter Operations with Cardiopulmonary Bypass
  1. Artem Bakanov,
  2. Alexandr Najmushin,
  3. Ivan Menshugin,
  4. Alexey Mihajlov,
  5. Andrey Bautin
  1. Almazov Federal Heart, Blood and Endocrinology Centre

Abstract

Background Hyperlactatemia is a well recognised marker of circulatory failure [1]. Several studies have shown a strong correlation between blood lactate levels and the risk of morbidity and mortality in varying clinical situations such as circulatory shock, septic shock, severe hypoxemia, liver failure, diabetes mellitus, and others [2]. After cardiac surgery, Hyperlactatemia is relatively common and is associated with morbidity and mortality. Hyperlactatemia occurs during cardiopulmonary bypass in patients undergoing operations for congenital cardiac disease and may be an early indicator for postoperative morbidity and mortality. It is a well-known fact that tissue hypoperfusion and inadequate oxygen delivery are associated with lactic acidosis owing to anaerobic metabolism [3]. The aim of the present study is to estimate the frequency and to reveal predictors of heperlactatemia occurrence in children with congenital heart diseases in the early postoperative period.

Methods This prospective study was spent in our centre between March and September 2007. Seventy two patients with congenital heart diseases operated in artificial blood circulation conditions from 1 till 17 years old were included in to the research. The study design was approved by the centre ethical committee. Written voluntary consent to participation in the scientific programme was signed by children’s parents. The induction to anaesthesia was performed in the presence of parents and includes the following components: Ketamin 7 mg/kg; Relanium 0.25 mg/kg; Atropine 0.015 mg/kg. After an approach of proof sedative effect the child was delivered to the operation room. Myoplegia was carried out by an intravenous injection of pipikuronium bromide 0.1 mg/kg. Artificial lungs ventilation was carried by Datex Ohmeda ADU AS-5 (Finland) (IPPV-mode).

Results We have obtained the following data: increase in lactate concentration > 5 mmol/l was marked in 2.37% blood samples. Time intervals analysis has shown, that maximal lactate concentration were observed in 7–11 hours after operation. There were no cases of heperlactatemia after 24 hours after operation. Having investigated interrelation between lactate and glucose concentration, we have found statistically authentic differences in glucose level > 9 mmol/l (r = 0.56). This interrelation was traced only in two time intervals: 1–6 and 7–11 hours after operation.

Conclusions Metabolic infringements in children with congenital heart diseases operated in artificial blood circulation conditions are observed in small percent of cases. Lactate concentration peak is observed in 7–11 hours interval after operation. There is no significant interrelation between artificial circulation time and heperlactatemia intensity in early postoperative period.

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