Change of Lactate Concentration During Hartmann Solution Infusion for Hepatic Resection
Condition: Hepatocellular Carcinoma; Liver Disease
MeSH terms: Carcinoma, Hepatocellular; Liver Diseases
Study type: Observational

Summary: 
      The investigators are trying to investigate metabolism of lactate sourced from IV Hartmann's
      solution in patients with hepatocellular carcinoma(HCC) compared with a control
      group(donation for liver transplantation) with normal liver function. Second purpose of this
      study is finding the predictive factor of changing metabolism of lactate sourced from IV
      Hartmann's solution in patients with HCC.
    

Detailed description: 
      The liver is important in acid-base physiology and electrolyte balance. It is important
      because it is a metabolically active organ which may be either a significant net producer or
      consumer of hydrogen ions.

      Lactate is produced in the peripheral tissues such as the muscles, skin, brain, and red blood
      cells and it is metabolized predominantly in the liver and kidneys, first to pyruvate and
      secondly to glucose. In the healthy liver, there is a net-uptake of lactate caused by
      gluconeogenesis, and the liver exhibits a higher net lactate clearance than any other organ
      anticipated to be up to 70% of the whole body clearance. Lactic acidosis will result if this
      hepatic metabolism is not adequate.

      Hartmann's solution, which contains 28 mmol/l of lactate and has a pH of 6.5, has been
      extensively used to maintain and replace intravascular volume in a variety of anesthetic
      procedures. Excessive use of saline has been observed to result in hyperchloraemic acidosis -
      which has been identified as a potential side effect of saline based solutions. It has been
      suggested that the use of balanced electrolyte solutions may avoid this effect.

      A previous study concerned that normal saline, which does not contain lactate, might be
      detrimental to liver donors because of an association with hyperchloremic metabolic acidosis.

      Metabolism of lactate sourced from IV Hartmann's solution also results in a net consumption
      of H+, but as this lactate was associated with Na+, the overall result is a net bicarbonate
      production. Effectively, metabolism of this lactate results in generation of an equivalent
      amount of bicarbonate. The investigators are evaluating about the metabolism of lactate
      sourced from IV Hartmann's solution in patients with HCC and donor for liver transplantation
      (control group).

      All patients underwent multiple medical assessments before surgery, including routine
      laboratory tests (complete blood counts, standard liver and renal function tests, coagulation
      tests, and viral serology), and electrocardiography, chest X-ray, hepatobiliary imaging,
      percutaneous liver biopsy, and indocyanine green retention testing (ICG test). Hartmann
      solution(Hartmann, Choongwae pharmaceutical, Seoul, Korea) solution is composed of 130 mmol/l
      sodium,109 mmol/l chloride, 4 mmol/l potassium,1.5 mmol/l calcium, and 28 mmol/l lactate, and
      has a pH of 6.5.

      Briefly, anesthesia was induced with thiopental sodium (5 mg/kg), and vecuronium(0.15 mg/kg).
      Endotracheal intubation was performed, and general anesthesia was maintained with sevoflurane
      (2-3 vol% in 50% air and oxygen). Throughout the surgery, the patients are monitored
      electrocardiography, pulse oximetry, capnography, esophageal temperature, invasive arterial
      pressure (via a radial artery catheter). Fluid administration(Hartmann solution) begin upon
      arrival in the operating room with 5ml/kg/hour rate. Acid-base status and lactate,
      electrolyte, and hemoglobin concentrations were assessed immediately and 2 hour after
      induction of anesthesia. The infusion rate of fluid is 5ml/kg/hour. The reasons of that rate
      are intravenous crystalloid administration has been restricted during hepatic dissection at
      the request of the surgeon and the investigators considered about the requirement of fluid
      loss. Mean arterial blood pressure >60mmHg and urine output >0.5 ml/kg/h were maintained
      during anesthesia. When mean arterial blood pressure was < 60 mmHg, the volume of fluid
      administered was increased initially and/or intravenous ephedrine (5-10 mg) was injected, as
      appropriate. If it cannot maintain the hemodynamic stability and need more fluid
      administration, the investigators manage other fluid administration or inotropics, and the
      case is withdrawn.

      Duration of 2 hours, volumes of Hartmann solution and the result of arterial blood gas
      analysis (Acid-base status and lactate, electrolyte, and hemoglobin concentrations were
      assessed immediately and 2 hour after induction of anesthesia) is recorded.

      The investigators compare the change of lactate level of patients with HCC and a control
      group( donation for liver transplantation) with normal liver function. After evaluating
      metabolism of exogenous lactate, the investigators are trying to find the predictive factor
      (among liver profile lab, MELD score, INR, functional liver volume, ICG test) of changing
      metabolism of lactate sourced from IV Hartmann's solution in patients with HCC.
    

Intervention name(s): hartmann solution
Intervention type(s): Other
Intervention description(s): hartmann solution infusion in patients for hepatic resection
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        patients with hepatocelluar carcinoma
      
Keywords: lactate; hartmann solution; hepatocellular carcinoma