Elsevier

International Journal of Surgery

Volume 20, August 2015, Pages 128-134
International Journal of Surgery

The effect of 0.9% saline versus plasmalyte on coagulation in patients undergoing lumbar spinal surgery; a randomized controlled trial

https://doi.org/10.1016/j.ijsu.2015.06.065Get rights and content
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Highlights

  • Perioperative fluid resuscitation with 0.9% saline is associated with hyperchloremic metabolic acidosis even in amounts of 2–4 L.

  • The changes on coagulation function assessed by rotation thromboelastometry are similar between 0.9% saline and plasmalyte.

  • Perioperative administration of plasmalyte resulted in greater intraoperative urine output compared with 0.9% saline.

Abstract

Introduction

In multi-level lumbar spinal fusion surgery yielding a large amount of blood loss, choice of fluid for volume resuscitation is an important issue since it can influence acid-base status, coagulation, and patients’ outcome. This study compared the effect of plasmalyte to 0.9% saline on coagulation assessed by rotation thromboelastometry (ROTEM) and acid-base balance in the aforementioned patients.

Methods

Fifty patients were randomly allocated to receive either 0.9% saline or plasmalyte during operation and until postoperative 12 h. ROTEM was performed at 10 min after anesthetic induction and end of surgery. Arterial blood gas analyses were serially performed from 10 min after anesthetic induction until postoperative 12 h. Fluid balance, blood loss, and transfusion requirement were assessed.

Results

ROTEM variables showed sporadic deterioration in both groups after surgery without intergroup differences. Intraoperatively, arterial pH, base excess, and bicarbonate concentrations were lower and serum chloride concentrations were higher in the 0.9% saline group compared with the plasmalyte group. The differences in base excess and bicarbonate concentrations persisted until postoperative 12 h. Fluid balance, blood loss, and transfusion requirement were similar between the groups while urine output was greater in the plasmalyte group compared with the 0.9% saline group (3.2 ± 1.6 ml/kg/h vs. 1.8 ± 1.1 ml/kg/h, p = 0.001).

Conclusion

In contrast to plasmalyte, fluid therapy with 0.9% saline resulted in transient hyperchloremic acidosis in patients undergoing multi-level lumbar spinal fusion, while coagulation assessed by ROTEM analysis and the amount of blood loss were similar between the groups.

Keywords

0.9% Saline
Plasmalyte
Acid-base balance
Coagulation

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This study was supported by a new faculty research seed money grant of Yonsei University College of Medicine for 2013 (8-2013-0017).