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BJA Advance Access published online on September 30, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei248
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted June 28, 2005

Clinical Investigation

Increased concentrations of L-lactate in the rectal lumen in patients undergoing cardiopulmonary bypass{dagger}

A. Perner 1*, V. L. Jørgensen 1, T. D. Poulsen 2, D. Steinbrüchel 3, B. Larsen 2, and L. W. Andersen 2

1 Department of Anaesthesia and Intensive Care, Herlev Hospital, University of Copenhagen, DK-2730 Herlev, Denmark
2 Department of Cardiothoracic Anaesthesia, Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
3 Department of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark

* To whom correspondence should be addressed.
A. Perner, E-mail: ap{at}dadlnet.dk


  Abstract

Background. Gut ischaemia may contribute to morbidity in patients after cardiopulmonary bypass (CPB), but little is known about the metabolic state of the large bowel in such patients. Therefore we estimated the concentrations of L-lactate and PCO2 in rectal mucosa in patients undergoing cardiac surgery with or without the use of CPB.

Methods. Patients undergoing coronary artery bypass grafting (CABG) (n=12) or off-pump CABG (n=10) were subjected to equilibrium dialysis of the rectal lumen during the procedure and in the first 4 h afterwards. Dialysate concentrations of L-lactate and PCO2 were measured using an auto-analyser and compared with values obtained in healthy subjects (n=10).

Results. During CPB, a 2- to 3-fold increase in luminal concentrations of L-lactate was observed (CABG vs off-pump CABG, P=0.05; CABG vs healthy subjects, P<0.01). The dialysate concentrations of L-lactate were higher than the mean systemic values (luminal-arterial gradient mean (SD) 0.9 (1.0) mmol litre-1, P<0.05), and the two values were positively correlated (P<0.05). Luminal L-lactate concentrations remained elevated 4 h after the operation. In contrast, dialysate PCO2 was equally high in patient and control groups and substantially higher than values observed in arterial blood.

Conclusions. Uncomplicated CPB is associated with moderate but sustained increases in luminal concentrations of L-lactate in the rectum, indicating metabolic dysfunction of the mucosa in the large bowel.

Keywords: gastrointestinal tract, mucosal perfusion; heart, cardiopulmonary bypass; metabolism, lactate; monitoring, carbon dioxide.
{dagger}Part of this study was presented at the 27th Congress of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine, Helsinki, Finland, 2003.
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