Effect of Fluid Therapy on Acid–Base Balance in Patients Undergoing Clipping for Ruptured Intracranial Aneurysm: A Prospective Randomized Controlled Trial

Abstract

Objectives Neurosurgical patients often receive 0.9% normal saline (NS) during the perioperative period. Theoretically, a balanced salt solution (BSS) is better than 0.9% saline. We compared the effects of two different fluids on acid–base balance, renal function, and neurological outcome in patients who underwent clipping following subarachnoid hemorrhage from a ruptured intracranial aneurysm.

Materials and Methods Patients in group NS (n = 30) received 0.9% saline and group BSS (N = 30) received BSS (Plasmalyte-A) in the perioperative period for 48 hours. Comparison of arterial pH, bicarbonate, and base deficit measured preoperatively, intraoperatively (first and second hour), and postoperatively (at 24 and 48 hours) was the primary outcome of the study. The secondary outcome compared serum electrolytes, renal function tests, urine neutrophil gelatinase-associated lipocalin (NGAL), serum cystatin C, and the neurological outcome using modified Rankin score (MRS) at discharge, 1, and 3 months.

Results In group NS, significantly low pH at 1-hour intraoperative period was seen compared with group BSS (7.37 ± 0.06 vs. 7.40 ± 0.05, p = 0.024). The bicarbonate level in group NS was significantly lower and the base deficit was higher at second intraoperative hour (bicarbonate: 17.49 vs. 21.99 mEq/L, p = 0.001; base deficit: 6.41 mmol/L vs. 1.89 mmol/L, p = 0.003) and at 24 hours post-surgery (bicarbonate: 20.38 vs. 21.96 mEq/L, p = 0.012; base deficit: 3.56 mmol/L vs. 2.12 mmol/L, p = 0.034)). Serum creatinine was higher in group NS at 24 hours (0.66 vs. 0.52 mg/dL, p = 0.013) and 48 hours (0.62 vs. 0.53 mg/dL, p = 0.047). Serum urea, electrolytes, cystatin, urine NGAL, and MRS were comparable.

Conclusion In neurosurgical patients undergoing clipping for ruptured intracranial aneurysm, using a BSS during the perioperative period is associated with a better acid–base and renal profile. However, the biomarkers of kidney injury and long-term outcomes were comparable.

Keywords

aneurysmal subarachnoid hemorrhage - balanced salt solution - fluid therapy - acid–base equilibrium - normal saline - neurosurgery - Plasmalyte

Authors' Contributions

S.K.S., N.B.P., and N.K. were involved in study conception and design, data collection, analysis and interpretation of results, and manuscript preparation. S.L.S. helped in study conception and design, data collection, and manuscript preparation. S.M. contributed to analysis and interpretation of results and manuscript preparation. M.K., S.P., and A.P. helped in study conception and design and data collection. S.S. and S.D. helped in data collection and analysis. M.T. contributed to study conception and design.

Note

This study was presented at 23rd Annual National Conference of Indian Society of Neuroanaesthesiology and Critical Care (ISNACC-2022) on January 21–23, 2022, Kolkata (Virtual mode) under Free Paper Original Article Category.

Ethical Approval

Ethical approval of this study was obtained from the Institutional Ethics Committee (INT/IEC/2020/SPL - 1088) on August 31, 2020, and the study was performed in accordance with the Helsinki Declaration of 1975, as revised in 2000.

Publication History

Article published online:
13 June 2024

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