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Volume 3 Supplement 1

ESICM LIVES 2015

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

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Introduction

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.

Objectives

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

Methods

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.

Results

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.

Conclusions

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].

References

  1. 1.

    Pereira B: 5-Aminolevulinic acid induced alterations of oxidative metabolism in sedentary and exercise trained rats. J Appl Physiol. 1992

  2. 2.

    Abbasova I: Lactate levels in patients who preoperatively receive 5-ALA. ESICM. 2009

  3. 3.

    Ottens TH: Effect of high-dose dexamethasone on perioperative lactate levels and glucose control: a randomized controlled trial. Crit Care. 2015

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Author information

Correspondence to G Baake.

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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Baake, G., van Gelder, F., Bult, W. et al. effect of 5-aminolaevulenic acid on postoperative lactate levels in patients undergoing surgery for malignant brain tumours. ICMx 3, A976 (2015) doi:10.1186/2197-425X-3-S1-A976

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Keywords

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