Evaluation of the effects of Plasmalyte 148 and 0.9% saline on fluid-electrolyte balance, acid-base balance, and renal function in patients undergoing neurosurgery
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Abstract Study objective: We evaluated the effects of Plasmalyte 148 and 0.9% saline on the acid-base and hydroelectrolytic balance in patients undergoing intracranial surgery. Design: Double-blind randomized controlled clinical trial. Setting: This study was conducted at the Clinical Hospital of Botucatu Medical School from January 2019 to February 2020. Patients: Adult patients undergoing intracranial surgery. Interventions: Patients were randomized to receive either Plasmalyte 148 or 0.9% saline at 2 mL.kg-1.hour-1. Fluid volume was adjusted according to variations in the mean arterial and pulse pressures. Measurements: Gasometry and plasma electrolyte samples were collected. The secondary outcome was postoperative renal function, according to KDIGO. Main results: Thirty-three and 35 patients in the Plasmalyte 148 and 0.9% saline groups, respectively, completed the study. The total (median [quartiles]) volumes of crystalloids administered were 2227 (1416, 3000) and 3000 (2000, 4000) in the Plasmalyte 148 and 0.9% saline groups, respectively (p = 0.107). Postoperatively, the mean (standard deviation) pH, HCO3-, and chloride values were 7.39 ± 0.04 and 7.35 ± 0.05 (p < 0.001), 22.5 ± 1.8 and 20.6 ± 2.2 mmol.l-1 (p < 0.001), and 109.1 ± 6.6 and 113.9 ± 4.5 mmol.l-1 (p = 0.001) in the Plasmalyte 148 and 0.9% saline groups, respectively. Serum calcium was reduced in the Plasmalyte 148 group compared to the 0.9% saline group (1.14 ± 0.04 versus 1.17 ± 0.05 mmol.l-1; p = 0.040). The numbers (%) of patients with a KDIGO stage ≥1 were 1 (3.0%) and 5 (14.3%) in the Plasmalyte 148 and 0.9% saline groups, respectively (p = 0.199). Conclusions: In a volume of approximately 3000 ml for fluid replacement in neurosurgeries, Plasmalyte 148 leads to less alteration in acid-base and hydroelectrolytic balance and must be considered, leading to better tissue perfusion and reduced morbidity. Keywords: Neurosurgery; fluid therapy; hydration; 0.9% saline; isotonic solutions.
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Design: Double-blind randomized controlled clinical trial. Setting: This study was conducted at the Clinical Hospital of Botucatu Medical School from January 2019 to February 2020. Patients: Adult patients undergoing intracranial surgery. Interventions: Patients were randomized to receive either Plasmalyte 148 or 0.9% saline at 2 mL.kg-1.hour-1. Fluid volume was adjusted according to variations in the mean arterial and pulse pressures. Measurements: Gasometry and plasma electrolyte samples were collected. The secondary outcome was postoperative renal function, according to KDIGO.