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Volume 3 Supplement 1


  • Poster presentation
  • Open Access

effect of 5-aminolaevulenic acid on postoperative lactate levels in patients undergoing surgery for malignant brain tumours

  • 1,
  • 1,
  • 1, 2 and
  • 1
Intensive Care Medicine Experimental20153 (Suppl 1) :A976

  • Published:


  • Malignant Glioma
  • Lactate Level
  • Liver Mitochondrion
  • Malignant Brain Tumour
  • Maximum Lactate


5-aminolaevulinic acid (5-ALA) is a natural precursor of haemoglobin. Exogenously administered 5-ALA can lead to intracellular accumulation of fluorescent porphyrins in malignant tissues, such as glioblastoma. 5-ALA is increasingly used to improve tumour visualisation and enable more optimal resection of malignant gliomas. In vitro, 5-ALA can cause oxidative damage to rat liver mitochondria. In vivo, rats exposed to 5-ALA developed increased lactate levels; possibly because inhibition of oxidative metabolism [1]. Univariate data also suggested an effect of 5-ALA in neurosurgical patients [2]. Since lactate levels are widely used to monitor patients, we performed multivariate analysis on the impact of 5-ALA on lactate levels.


Asses the relation of preoperative 5-ALA on postoperative systemic lactate levels in patients undergoing surgery for malignant brain tumours.


In an observational study in a cohort of neurosurgical patients who underwent resection of a suspected malignant glioma and were postoperatively admitted to our ICU, we compared lactate levels between patients who received 5-ALA preoperatively (5-ALA group) and those who did not (control group). The decision to use 5-ALA was at the discretion of the neurosurgeon and was based on the specific tumour characteristics on preoperative imaging. If fluorescent-guided resection was scheduled, the patient received 20 mg/kg of 5-ALA (Gliolan, Medac, Germany) orally 2 hours before the induction of anaesthesia. All patients received high-dose dexamethasone. Peri- and postoperative lactate and glucose levels were routinely obtained during the ICU stay in all included patients in this study using a point-of-care analyzer blood gas analyser.


From 2007 to 2014 we included 350 patients aged 56 ± 14, 60% males. 89 patiens (25%) received 5-ALA. These patients were older than controls (62 ± 8 vs. 53 ± 15;p < 0.001); duration of operation did not differ between the control and 5-ALA groups (NS). On day 0 the mean maximum lactate in the 5-ALA vs control groups was 2.83 ± 1.34 vs 2.47 ± 1.24 mmol/L (p = 0.02). On the first postoperative day the lactate levels were similar. Multivariate analysis showed that age (p = 0.02), duration of operation (p = 0.04) and glucose (p < 0.001), but not 5-ALA (p = 0.43) were related with lactate.


5-ALA use was only univariately associated with increased postoperative lactate levels. MV-analysis, strongly points to a central role of hyperglycemia, as was recently also observed after cardiac surgery [3].

Authors’ Affiliations

Department of Critical Care, University Medical Center Groningen, Groningen, Netherlands
Hospital Pharmacy, University Medical Center Groningen, Groningen, Netherlands


  1. Pereira B: 5-Aminolevulinic acid induced alterations of oxidative metabolism in sedentary and exercise trained rats. J Appl Physiol. 1992Google Scholar
  2. Abbasova I: Lactate levels in patients who preoperatively receive 5-ALA. ESICM. 2009Google Scholar
  3. Ottens TH: Effect of high-dose dexamethasone on perioperative lactate levels and glucose control: a randomized controlled trial. Crit Care. 2015Google Scholar


© Baake et al.; 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.