Temporary hyperlactataemia during partial hepatectomy: Report of two cases

Area of Science:

• Hepatobiliary Surgery
• Anesthesiology
• Critical Care Medicine

Background:

• Lactic acidosis (LA) is a serious metabolic disturbance characterized by lactate accumulation.
• Perioperative LA is infrequently encountered, particularly during major hepatic resections.
• Maintaining hemodynamic stability and optimizing surgical techniques are crucial in preventing metabolic complications.

Purpose of the Study:

• To report two cases of temporary hyperlactatemia during partial hepatectomy.
• To identify potential contributing factors to perioperative LA in liver surgery.
• To discuss strategies for managing and preventing LA during prolonged hepatectomy.

Main Methods:

• Case report of two patients undergoing partial hepatectomy.
• Analysis of intraoperative physiological parameters, including central venous pressure.
• Review of surgical techniques, specifically hepatic vascular occlusion and parenchymal resection duration.

Main Results:

• Both patients experienced transient hyperlactatemia during extended partial hepatectomy.
• Prolonged hypovolemia due to controlled low central venous pressure was implicated.
• Overuse of hepatic vascular occlusion technique was also identified as a contributing factor.

Conclusions:

• Extended hepatectomy, particularly with controlled low central venous pressure and extensive vascular occlusion, poses a risk for perioperative lactic acidosis.
• Careful hemodynamic management and judicious application of surgical techniques are essential to prevent LA.
• Prompt recognition and appropriate management are key to addressing hyperlactatemia in this setting.