[Intraoperative lactic acidosis, can it be treated? Clinico-experimental, prospective, sequential study].
OBJECTIVE: To verify the efficacy and absence of risk attributable to therapy with alkaline solutions for correction of lactic acidosis and to demonstrate the usefulness of L-carnitine in converting lactate into pyruvate in conditions of good blood oxygenation. DESIGN: Prospective study on a consecutive series of patients subdivided into three groups following the use of: alkalinizing therapy (group I), L-carnitine (group II), or saline solution (group III). Groups 1 and 2 were further subdivided into subgroups "a" and "b" according to the type of alkalinizing agent and of L-carnitine somministration. SETTING: Teaching Hospital-Torrette di Ancona. PATIENTS: 65 patients submitted to major vascular surgery with aortic clamping in the time period between January 1992 and August 1993. INTERVENTIONS: During aortic clamping patients of: group I received 2 mEq:kg of bicarbonate or tromentamolo according to the specific subgroup. Group II received a bolus of 2 g of L-carnitine, patients of group IIb received further 2 g of carnitine in continuous perfusion until the end of surgery. Group III received no pharmacological intervention. MEASUREMENTS: HR BP, arterial blood gases and lactic acid levels were measured at 12 pre-determined times. RESULTS: Only a neutralizing effect of alkalinizing therapy was observed, whereas the lactic acid measurements demonstrated no significant differences between the different groups. CONCLUSIONS: These results confirm the data of other Authors concerning the good compliance of alkalinizing therapy, however, there was demonstrated no clear evidence of its effective usefulness. No metabolic stimulation due to L-canitina could be demonstrated in our experimental conditions.