Effect of Propofol on Metabolic Acidosis in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass

Propofol has been associated with metabolic acidosis in case reports. However, the results of studies in patients undergoing non-cardiac surgery are controversial. On the other hand, there have been no randomized controlled studies addressing this issue in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). In this study, we investigated whether propofol was associated with metabolic acidosis in patients undergoing cardiac surgery with CPB.

Forty patients undergoing cardiac surgery with CPB were randomly assigned to receive total anesthesia with propofol (intervention group) or sevoflurane (control group), respectively. Except for this, the anesthetic and surgical management was the same in all patients. The primary outcomes were the changes in arterial blood pH, base excess, HCO_3^-, and lactate levels during surgery. The secondary outcomes included serum aspartate transaminase (AST), alanine transaminase (ALT), urea, and creatinine levels, as well as the proportion of patients with increased liver enzymes and kidney damage at the end of surgery, and the proportion of patients with arrhythmia during surgery.

The rate of metabolic acidosis with high lactate at the end of surgery in the propofol group (intervention group) was statistically higher than that in the sevoflurane group (control group). Nevertheless, no difference in serum AST, ALT, urea, and creatinine levels between the two groups, and the proportions of patients with increased liver enzymes and kidney damage at the end of surgery, as well as the proportion of patients with arrhythmia during surgery.

Total anesthesia with propofol was associated with metabolic acidosis but did not significantly affect increased liver enzymes, kidney damage, and arrhythmias when compared with the control group in patients undergoing cardiac surgery with CPB.