Frequency of hyperlactatemia in craniotomy and its association with anesthesia: A prospective observational study

Lactate plays a crucial role in neuroanesthesia, and dysregulated lactate metabolism is hypothesized to contribute to carcinogenesis. Serum lactate has been suggested as a potential biomarker for tumor malignancy and a prognostic factor in patients with brain tumors. However, the clinical significance of intraoperative hyperlactatemia in brain tumor surgery and its relationship with anesthesia technique remain unclear. The aim of this study was to investigate the incidence of hyperlactatemia in brain tumor surgeries and its association with the type of maintenance anesthesia, as well as to examine its relationship with other potential risk factors. A total of 109 brain tumor cases scheduled for elective craniotomy were analyzed. All patients received general anesthesia, and maintenance anesthesia was managed using either total intravenous anesthesia or inhalation anesthesia. The assignment of anesthesia technique was not randomized and was mainly based on intraoperative neuromonitoring needs. The patients' lactate levels were measured after the induction of anesthesia (baseline), 1 hour after the start of surgery, and immediately after extubation. Hyperlactatemia occurred in 66 of the 109 patients (60.6%). Analysis of the intraoperative variations in lactate levels revealed a parallel increase in both the total intravenous anesthesia and inhalation groups (P = .37), and there was no statistically significant difference between them (P = .19). Patients with glial tumors had higher lactate levels than those with non-glial tumors (P = .001), and lactate levels in grade 4 brain tumors were significantly higher than those of grade 1 tumors (P = .003). This study demonstrates that hyperlactatemia is a common finding in brain tumor cases, and the preference for total intravenous or inhalation anesthesia during craniotomy does not have a significant impact on serum lactate levels. Markedly elevated lactate levels in brain tumor cases should be considered as a possible reflection of tumor aggressiveness or higher grade.