A comparison of Plasmalyte 148 and 0.9% saline for intra-operative fluid replacement.
Thirty patients undergoing major hepatobiliary or pancreatic surgery were randomly allocated to receive either 0.9% saline or Plasmalyte 148 (a balanced salt solution), at 15 ml.kg-1.h-1. Arterial blood gas analysis was performed before and after surgery. Plasma biochemistry (Na+, K+, Cl-, lactate) measurements were made before and after surgery and at 24 h after surgery. The patients receiving 0.9% saline had significantly increased chloride concentrations (p < 0.01), decreased standard bicarbonate concentrations (p < 0.01) and increased base deficit (p < 0.01) compared to those receiving Plasmalyte 148. There were no significant changes in plasma sodium or potassium or blood lactate concentrations in either group. The exclusive use of 0.9% saline intra-operatively can produce a temporary hyperchloraemic acidosis which could be given false pathological significance. In addition it may exacerbate an acidosis resulting from an actual pathological state. The use of a balanced salt solution such as Plasmalyte 148 may avoid these complications.
Department of Anaesthetics and Intensive Care, Royal Infirmary, Edinburgh.
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McFarlane
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Lee
D000085:Acetates / Q000008:administration & dosage; D000136:Acid-Base Equilibrium; D001639:Bicarbonates / Q000097:blood; D002712:Chlorides / Q000097:blood; D005260:Female; D005440:Fluid Therapy; D005942:Gluconates / Q000008:administration & dosage; D006801:Humans; D007430:Intraoperative Care; D008099:Liver / Q000601:surgery; D015636:Magnesium Chloride / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery; D011189:Potassium Chloride / Q000008:administration & dosage; D019346:Sodium Acetate; D012965:Sodium Chloride / Q000008:administration & dosage
D000085:Acetates; D001639:Bicarbonates; D002712:Chlorides; D005942:Gluconates; C012499:Plasma-lyte 148; D015636:Magnesium Chloride; D012965:Sodium Chloride; D019346:Sodium Acetate; D011189:Potassium Chloride