Normal saline versus lactated Ringer's solution for intraoperative fluid management in patients undergoing abdominal aortic aneurysm repair : An outcome study

• Published in: Anesthesia and analgesia Vol. 93; no. 4; pp. 817 - 822
• Main Authors: WATERS, Jonathan H, GOTTLIEB, Alexandru, SCHOENWALD, Peter, POPOVICH, Marc J, SPRUNG, Juraj, NELSON, David R
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01.10.2001
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aortic Aneurysm, Abdominal - surgery; Biological and medical sciences; Blood Gas Analysis; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Female; Fluid Therapy; Humans; Intraoperative Period; Isotonic Solutions; Male; Medical sciences; Middle Aged; Respiration, Artificial; Ringer's Solution; Sodium Chloride; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Treatment Outcome; Vascular Surgical Procedures; Human; Ringer lactate; Intravenous administration; Electrolyte solution; Aneurysm; Cardiovascular disease; Ringer solution; Arterial disease; Vascular disease; Abdominal aorta; Acid base balance; Crystalloid solution; Perfusion; Surgery; Aorta; Complication; Aortic disease; Metabolic acidosis; Comparative study
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1097/00000539-200110000-00004

Metabolic acidosis and changes in serum osmolarity are consequences of 0.9% normal saline (NS) solution administration. We sought to determine if these physiologic changes influence patient outcome. Patients undergoing aortic reconstructive surgery were enrolled and were randomly assigned to receive lactated Ringer's (LR) solution (n = 33) or NS (n = 33) in a double-blinded fashion. Anesthetic and fluid management were standardized. Multiple measures of outcome were monitored. The NS patients developed a hyperchloremic acidosis and received more bicarbonate therapy (30 +/- 62 mL in the NS group versus 4 +/- 16 mL in the LR group; mean +/- SD), which was given if the base deficit was greater than -5 mEq/L. The NS patients also received a larger volume of platelet transfusion (478 +/- 302 mL in the NS group versus 223 +/- 24 mL in the LR group; mean +/- SD). When all blood products were summed, the NS group received significantly more blood products (P = 0.02). There were no differences in duration of mechanical ventilation, intensive care unit stay, hospital stay, and incidence of complications. When NS was used as the primary intraoperative solution, significantly more acidosis was seen on completion of surgery. This acidosis resulted in no apparent change in outcome but required larger amounts of bicarbonate to achieve predetermined measurements of base deficit and was associated with the use of larger amounts of blood products. These changes should be considered when choosing fluids for surgical procedures involving extensive blood loss and requiring extensive fluid administration. Predominant use of 0.9% saline solution in major surgery has little impact on outcome as assessed by duration of mechanical ventilation, intensive care unit stay, hospital stay, and postoperative complications, but it does appear to be associated with increased perioperative blood loss.