Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(03): 386-394
DOI: 10.1055/s-0044-1787086
Original Article

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

Senthil Kumaran Sundaram
1   Department of Anaesthesia and Intensive Care, Post Graduate, Institute of Medical Education and Research, Chandigarh, India
,
Nidhi Bidyut Panda
2   Division of Neuroanaesthesia, Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Narender Kaloria
1   Department of Anaesthesia and Intensive Care, Post Graduate, Institute of Medical Education and Research, Chandigarh, India
,
Shiv Lal Soni
1   Department of Anaesthesia and Intensive Care, Post Graduate, Institute of Medical Education and Research, Chandigarh, India
,
Shalvi Mahajan 
1   Department of Anaesthesia and Intensive Care, Post Graduate, Institute of Medical Education and Research, Chandigarh, India
,
Madhivanan Karthigeyan
3   Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Smita Pattanaik
4   Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Sheetal Singh
4   Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Sumit Dey
5   Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Arnab Pal
6   Department of Biochemistry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Manjul Tripathi 
3   Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
› Author Affiliations Funding This work was supported by the Department of Anesthesia and Intensive care, Postgraduate Institute of Medical Education and Research, Chandigarh.

Clinical Trial Registration Number Clinical Trial Registry of India (CTRI/2020/09/028078) on 28 September 2020 (www.ctri.nic.in).
› Further Information
Also available at
   Permissions and Reprints
Zoom Image

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

© 2024. 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/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India