Effect of Dexamethasone on Perioperative Lactate Levels in Donor Hepatectomy: Dexamethasone and Lactate in Donor Hepatectomy

. Rabia; Muhammad Hussan Farooq; Muhammad Ashraf; Zuhair Ali Rizvi; Muhammad Nasir Ayub Khan; Muhammad Zakria Amjad; Saad Ahmed Naveed

doi:10.54393/pjhs.v6i7.3107

Authors

. Rabia St. James's Hospital, Dublin, Ireland
Muhammad Hussan Farooq Department of Anesthesia, Shifa International Hospital, Islamabad, Pakistan
Muhammad Ashraf Department of Anesthesia, Shifa International Hospital, Islamabad, Pakistan
Zuhair Ali Rizvi Department of Anesthesia, Shifa International Hospital, Islamabad, Pakistan
Muhammad Nasir Ayub Khan Department of Anesthesia, Shifa International Hospital, Islamabad, Pakistan
Muhammad Zakria Amjad Department of Anesthesia, Shifa International Hospital, Islamabad, Pakistan
Saad Ahmed Naveed Department of Anesthesia, Shifa International Hospital, Islamabad, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i7.3107

Keywords:

Dexamethasone, Hyperlactatemia, Liver Donor Hepatectomy, Perioperative Lactate

Abstract

The use of intravenous dexamethasone intraoperatively has been advocated for analgesia, prevention of nausea and vomiting, post-operative sore throat and inflammation. Hyperlactinemia associated with dexamethasone is a concern in patients undergoing hepatectomy. There is limited evidence to support safety or adversity of dexamethasone in terms of hyperlactinemia. Objective: To evaluate the effect of dexamethasone administration on perioperative lactate levels in living related donors undergoing liver donor right hepatectomies. Methods: The 60 patients who had donor hepatectomy appointments in total were divided into two groups at random. After the induction of anesthesia, Group B (n=30) got dexamethasone at a dose of 8 mg while Group A (n=30) received a placebo. Perioperative lactate levels were assessed at various time points, and statistical comparisons were made between the two groups' mean lactate levels. Results: The patients' mean age was 25.68 years, and their mean BMI was 21.48 kg/m2. At every time point, Group B displayed significantly higher mean lactate levels than Group A (p=0.000). Additionally, there were statistically significant differences between the groups, an hour after drug administration, and after graft extraction (p=0.000). The perioperative mean glucose level climbed steadily in both groups. Conclusion: The administration of dexamethasone in patients undergoing right living related donor hepatectomy was associated with significantly higher perioperative lactate levels compared to patients receiving placebo.

References

Amer K, Elmoghazy W, Abdelhady M, Alsawak A, El Fayoumie M, Alaboudy A et al. Surgical outcomes after donor hepatectomy for adult living-donor liver transplants: A single-center experience. Journal of Liver Transplantation. 2021 Apr; 2: 100023. doi: 10.1016/j.liver.2021.100023.

Li X, Yang Y, Zhang B, Lin X, Fu X, An Y et al. Lactate metabolism in human health and disease. Signal Transduction and Targeted Therapy. 2022 Sep; 7(1): 305. doi: 10.1038/s41392-022-01151-3.

Ottens TH, Nijsten MW, Hofland J, Dieleman JM, Hoekstra M, Van Dijk D et al. Effect of high-dose dexamethasone on perioperative lactate levels and glucose control: a randomized controlled trial. Critical Care. 2015 Dec; 19(1): 41. doi: 10.1186/s13054-015-0736-9.

Edinoff AN, Houk GM, Patil S, Siddaiah HB, Kaye AJ, Iyengar PS et al. Adjuvant drugs for peripheral nerve blocks: the role of alpha-2 agonists, dexamethasone, midazolam, and non-steroidal anti-inflammatory drugs. Anesthesiology and Pain Medicine. 2021 Jul; 11(3): e117197. doi: 10.5812/aapm.117197.

Polderman JA, Farhang‐Razi V, Van Dieren S, Kranke P, DeVries JH, Hollmann MW et al. Adverse side effects of dexamethasone in surgical patients. Cochrane Database of Systematic Reviews. 2018: (8). doi: 10.1002/14651858.CD011940.pub2.

Joetten L, Steinkraus KC, Traub B, Graf S, Mihaljevic AL, Kornmann M et al. Impact of perioperative steroid administration in patients undergoing elective liver resection: meta-analysis. BJS Open. 2022 Dec; 6(6): zrac139. doi: 10.1093/bjsopen/zrac139.

Onoe S, Yokoyama Y, Ebata T, Nagino M. ASO Author Reflections: Is Perioperative Steroids Administration Beneficial for Patients Undergoing Major Hepatectomy with Extrahepatic Bile Duct Resection?. Annals of Surgical Oncology. 2020 Dec; 27(Suppl 3): 808-9. doi: 10.1245/s10434-020-08804-z.

Vitin AA, Azamfirei L, Tomescu D, Lang JD. Perioperative management of lactic acidosis in end-stage liver disease patient. The Journal of Critical Care Medicine. 2017 May; 3(2): 55. doi: 10.1515/jccm-2017-0014.

Niederwieser T, Braunwarth E, Dasari BV, Pufal K, Szatmary P, Hackl H et al. Early postoperative arterial lactate concentrations to stratify risk of post-hepatectomy liver failure. British Journal of Surgery. 2021 Nov; 108(11): 1360-70. doi: 10.1093/bjs/znab338.

Recknagel S, Rademacher S, Höhne C, Lederer AA, Lange UG, Herta T et al. Prediction of the postoperative outcome in liver resection using perioperative serum lactate levels. Journal of Clinical Medicine. 2023 Mar; 12(6): 2100. doi: 10.3390/jcm12062100.

Watanabe I, Mayumi T, Arishima T, Takahashi H, Shikano T, Nakao A et al. Hyperlactemia can predict the prognosis of liver resection. Shock. 2007 Jul; 28(1): 35-8. doi: 10.1097/shk.0b013e3180310ca9.

Gaspari R, Teofili L, Ardito F, Adducci E, Vellone M, Mele C et al. High arterial lactate levels after hepatic resection are associated with low oxygen delivery and predict severe postoperative complications. Biomedicines. 2022 May; 10(5): 1108. doi: 10.3390/biomedicines10051108.

O'Hara Jr JF, Tetzlaff JE, Smith MP. Severe perioperative lactic acidosis: how clinically significant is it?. Cleveland Clinic Journal of Medicine. 1994 Jul; 61(4): 314-6. doi: 10.3949/ccjm.61.4.314.

Wang DD, Dong MM, Xie YM, Xu FQ, Fu TW, Wu YC et al. Effect of early peri-operative arterial lactate concentration level ratios on post-hepatectomy liver failure. Discover Oncology. 2024 Mar; 15(1): 81. doi: 10.1007/s12672-024-00911-7.

Ersoy Z, Araz C, Kırnap M, Zeyneloğlu P, Torgay A, Arslan G. Anesthesia Management of a Deceased Cadaveric-Donor Combined Liver and Kidney Transplant for Primary Hyperoxaluria Type 1: Report of a Case. Experimental and Clinical Transplantation. 2015 Nov; 3: 97-100. doi: 10.6002/ect.tdtd2015.P60.

Myles PS, Dieleman JM, Forbes A, Heritier S, Smith JA. Dexamethasone for Cardiac Surgery trial (DECS-II): rationale and a novel, practice preference-randomized consent design. American Heart Journal. 2018 Oct; 204: 52-7. doi: 10.1016/j.ahj.2018.06.008.

DREAMS Trial Collaborators, West Midlands Research Collaborative. Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial). British Medical Journal. 2017 Apr; 357. doi: 10.1136/bmj.j1455.

Nazar CE, Lacassie HJ, Lopez RA, Muñoz HR. Dexamethasone for postoperative nausea and vomiting prophylaxis: effect on glycaemia in obese patients with impaired glucose tolerance. European Journal of Anaesthesiology. 2009 Apr; 26(4): 318-21. doi: 10.1097/EJA.0b013e328319c09b.

Hai HH, Aw P, Teng TZ, Shelat VG. Perioperative steroid administration reduces overall complications in patients undergoing liver resection: A meta-analysis. World Journal of Gastrointestinal Surgery. 2021 Sep; 13(9): 1079. doi: 10.4240/wjgs.v13.i9.1079.

Huang Y, Xu L, Wang N, Wei Y, Wang W, Xu M et al. Preoperative dexamethasone administration in hepatectomy of 25-min intermittent Pringle's maneuver for hepatocellular carcinoma: a randomized controlled trial. International Journal of Surgery. 2023 Nov; 109(11): 3354-64. doi: 10.1186/s13063-023-07820-0.