Comparison of post-operative acidemia after intraoperative administration of balanced crystalloid plasma – Lyte A® vis-a-vis 0.9% sodium chloride in gastrointestinal surgery at a tertiary care hospital in Eastern India

Abstract

Background: Fluid therapy is the most challenging and debatable aspect of perioperative care. Choice of administrating intravenous fluid perioperative period varies considerably among anesthesiologist. Aims and Objectives: The aims of this study were to compare the effects of intraoperative administration of balanced crystalloid solution (Plasma-Lyte A®) and 0.9% sodium chloride (NaCl) on acid–base balance in the post-operative period on patients undergoing gastro intestinal surgery at a tertiary care hospital. Materials and Methods: A prospective, randomized, comparative, and observational study was conducted on 80 patients of either sex aged 18–60 years with ASA-l and ASA-II who underwent gastrointestinal surgery which was at first randomly allocated to two equal groups of 40 each. Group 1 received Plasma-Lyte A® as the sole crystalloid and Group 2 received 0.9% NaCl. Intraoperative crystalloid infusion volumes, urinary output, blood loss, and blood transfusion volumes were recorded on hourly basis. Electrolytes (Na+, K+) and arterial blood gases were measured after induction of anesthesia and then every hour in the intraoperative period and at the 1st, 6th, and 12th hour of post-operative period. Results: The demographic data with respect to age, sex, and type of surgery were comparable among the two groups with no significant difference (P>0.05). Intraoperative and post-operative fluid transfusion and blood transfusion were also comparable with no significant difference. On intergroup comparison, serum Na+ conc. of both the groups was comparable and no difference shown at the time of induction, but after 12 hours following operation, there was a significant increase in Group 2 (P<0.05). There was no significant difference in serum K+ concentration in both the groups except at 6-hour postoperatively, there was an increase in K+ concentration in Group 1 (P<0.05). Serum Cl- concentration at post-operative 1st, 6th, and 12th hour interval very significantly increased in Group 2 (P<0.001). A significant decrease in pH (P<0.05) observed in 0.9% NaCl group in comparison to Plasma-Lyte® group when the duration of surgery increased to more than 120 minutes. Conclusion: Plasma-Lyte A® and 0.9% NaCl can be used safely during gastrointestinal surgery as the sole crystalloid. However, chance of developing hyperchloremic metabolic acidosis is more with 0.9% NaCl than Plasma-Lyte A® in prolonged surgery exceeding 2 hours.

Keywords

• acid–base balance; crystalloid intravenous fluid; laparotomy