Effect of Normal Saline versus PlasmaLyte on Coagulation and Metabolic Status in Patients Undergoing Neurosurgical ProceduresFunding None.
Background The choice of intraoperative fluid in neurosurgical patients is important as we need to maintain adequate cerebral perfusion and oxygenation and also avoid cerebral edema. Normal saline (NS) is commonly used in neurosurgeries, but it leads to hyperchloremic metabolic acidosis, which may result in coagulopathy. Balanced crystalloid with physiochemical composition akin to that of plasma has favorable effects on metabolic profile and may avoid the problems associated with NS. Against this background, the present study aimed to compare the effects of NS versus PlasmaLyte (PL) on coagulation profile in patients undergoing neurosurgical procedures.
Methods This prospective, randomized, double-blinded study was conducted in 100 adult patients scheduled to undergo various neurosurgical procedures. Patients were randomly allocated in two groups of 50 each to receive either NS or PL intraoperatively and postoperatively till 4 hours after the surgery. Hemoglobin, hematocrit, coagulation profile (PT, PTT, and INR), serum chloride, pH, blood urea, and serum creatinine were measured prior to induction (baseline) and 4 hours after completion of surgery.
Results Demographic characteristics were statistically similar between the two groups. Coagulation profile parameters were comparable between the two groups at baseline as well as 4 hours after surgery. pH was significantly lower in the NS group as compared to the PL group at 4 hours after surgery. Postoperatively blood urea, serum creatinine, and serum chloride levels were significantly raised in the NS group as compared to the PL group. Hemoglobin and hematocrit values were similar between the two groups.
Conclusion Coagulation profile parameters were normal and statistically similar with intraoperative infusion of NS versus PL in patients undergoing neurosurgical procedures. However, use of PL was associated with a better acid–base and renal profile in these patients.
Institutional Ethics Committee Approval No.- IEC/Th/19/Anst17.
Artikel online veröffentlicht:
07. Juni 2023
© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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- 1 Young JBL, Utter GH, Schermer CR. et al. Saline versus Plasma-Lyte A in initial resuscitation of trauma patients: a randomized trial. Ann Surg 2014; 259 (02) 255-262
- 2 Hafizah M, Liu CY, Ooi JS. Normal saline versus balanced-salt solution as intravenous fluid therapy during neurosurgery: effects on acid-base balance and electrolytes. J Neurosurg Sci 2017; 61 (03) 263-270
- 3 Dey A, Adinarayanan S, Bidkar PU, Bangera RK, Balasubramaniyan V. Comparison of normal saline and balanced crystalloid (plasmalyte) in patients undergoing elective craniotomy for supratentorial brain tumors: a randomized controlled trial. Neurol India 2018; 66 (05) 1338-1344
- 4 Song JW, Shim JK, Kim NY, Jang J, Kwak YL. The effect of 0.9% saline versus plasmalyte on coagulation in patients undergoing lumbar spinal surgery; a randomized controlled trial. Int J Surg 2015; 20: 128-134
- 5 Nuttall GA, Stehling LC, Beighley CM, Faust RJ. American Society of Anesthesiologists Committee on Transfusion Medicine. Current transfusion practices of members of the American Society of Anesthesiologists: a survey. Anesthesiology 2003; 99 (06) 1433-1443
- 6 Hahn RG. Adverse effects of crystalloid and colloid fluids. Anaesthesiol Intensive Ther 2017; 49 (04) 303-308
- 7 Shin HJ, Na HS, Jeon YT, Lee GW, Do SH. Changes in blood coagulation after colloid administration in patients undergoing total hip arthroplasty: comparison between pentastarch and tetrastarches, a randomized trial. Korean J Anesthesiol 2015; 68 (04) 364-372
- 8 Van der Linden P, Ickx BE. The effects of colloid solutions on hemostasis. Can J Anaesth 2006; 53 (6, Suppl): S30-S39
- 9 Martin G, Bennett-Guerrero E, Wakeling H. et al. A prospective, randomized comparison of thromboelastographic coagulation profile in patients receiving lactated Ringer's solution, 6% hetastarch in a balanced-saline vehicle, or 6% hetastarch in saline during major surgery. J Cardiothorac Vasc Anesth 2002; 16 (04) 441-446
- 10 Handy JM, Soni N. Physiological effects of hyperchloraemia and acidosis. Br J Anaesth 2008; 101 (02) 141-150