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LETTER TO EDITOR
Year : 2011  |  Volume : 55  |  Issue : 4  |  Page : 423  

Serum lactate levels and tissue hypoperfusion in complex corrective paediatric cardiac surgeries


Department of Anaesthesiology, Government Medical College and Superspeciality Hospital, Nagpur, Maharashtra, India

Date of Web Publication13-Sep-2011

Correspondence Address:
Abhiruchi Patki
Department of Anaesthesiology, Government Medical College and Superspeciality Hospital, Nagpur, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.84823

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How to cite this article:
Patki A. Serum lactate levels and tissue hypoperfusion in complex corrective paediatric cardiac surgeries. Indian J Anaesth 2011;55:423

How to cite this URL:
Patki A. Serum lactate levels and tissue hypoperfusion in complex corrective paediatric cardiac surgeries. Indian J Anaesth [serial online] 2011 [cited 2021 Jul 30];55:423. Available from: https://www.ijaweb.org/text.asp?2011/55/4/423/84823

Sir,

I read with interest the article titled, "Pulse oximeter accuracy and precision at five different sensor locations in infants and children with cyanotic heart disease", by Das et al., [1] in the November-December issue of the journal. I congratulate the authors on their well-conceived article; however, one point could do with some clarification.

The authors included 50 children posted for various cyanotic congenital heart correction surgeries (including transposition of great arteries, Fallot's tetralogy, etc.) and the observations were primarily done within 3 hours of the postoperative period in which they compared pulse oximeter measurements with arterial oxygen saturation measurements.

Lactate levels above 2 mmol/l were one of their exclusion criteria, and although they have not mentioned the timing of serum lactate measurement anywhere, it can be assumed that those were taken in the immediate postoperative period, i.e. within 3 hours postoperatively. Serum lactate levels were probably taken in order to rule out tissue hypoperfusion which would otherwise interfere with the pulse oximeter findings.

Quite a few number of studies done earlier on serum lactate levels in the initial postoperative period in paediatric cardiac surgery have shown that it takes a considerable time for serum lactate levels to come down any closer to 2 mmol/l. [2],[3] With an increase in surgical complexity of the procedure and resultant greater cross-clamp and cardiopulmonary bypass times, the serum lactate levels tend to be very high in the initial postoperative period. [4],[5]

A remarkable sample size of 50, with lactate levels below 2 mmol/l in each case in the early postoperative period, is rather difficult to achieve.

 
   References Top

1.Das J, Aggarwal A, Aggarwal NK. Pulse oximeter accuracy and precision at five different sensor locations in infants and children with cyanotic heart disease. Indian J Anaesth 2010;54:531-4.   Back to cited text no. 1
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2.Siegel B, Dalton HJ, Hertzog JH, Hopkins RA, Hannan RL, Hauser GJ. Initial postoperative serum lactate levels predict survival in children after open heart surgery. Intensive care Med 1996;22:1418-23.  Back to cited text no. 2
    
3.Kalyanaraman M, De Campli WM, Campbell AI, Bhalala U, Harman TG, Sandiford P, et al. Serial blood lactate levels as a predictor of mortality in children after cardiopulmonary bypass surgery. Paediatr Crit Care Med 2008;9:285-8.  Back to cited text no. 3
    
4.Cheifetz I, Kern FH, Schulman SR, Greeley WJ, Ungerleider RM, Meliones J. Serum lactates correlate with mortality after operations for complex congenital heart disease. Ann Thorac Surg 1997;64:735-8.  Back to cited text no. 4
    
5.Munoz R, Laussen P, Guillermo P, Zienko L, Piercey G, Wessel DL. Changes in whole blood lactate levels during cardiopulmownary bypass for surgery for congenital cardiac disease: An early indicator of morbidity and mortality. J Thorac Cardiovasc Surg 2000;119:155-62.  Back to cited text no. 5
    




 

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