Sequential perioperative lactate determination. Physiological and clinical implications.

Sequential arterial blood lactate concentrations were determined pre-, intra-, and postoperatively in 12 high risk surgical patients. These levels were correlated with simultaneous measurements of arterial blood pressure, cardiac index (CI), and oxygen consumption (VO2). There was a marked increase in lactate values intraoperatively. This increase did not correspond to decreases in either mean arterial pressure (MAP) or CI, but did appear to correlate with decreased intraoperative VO2. Postoperatively, lactate levels remained elevated, and this elevation appeared to correlate with an estimation of intraoperative oxygen deficit. CI and VO2 were increased postoperatively; the data support the hypothesis that these postoperative increases in CI and VO2 represent physiological compensations for intraoperative oxygen deficits. Clinically, determinations of lactate values may prove useful in titrating postoperative therapy to support needed physiological compensations.