title: Normal saline versus lactated Ringer's solution for intraoperative fluid management in patients undergoing abdominal aortic aneurysm repair: an outcome study.
abstract: Metabolic acidosis and changes in serum osmolarity are consequences of 0.9% normal saline (NS) solution administration. We sought to determine if these physiologic changes influence patient outcome. Patients undergoing aortic reconstructive surgery were enrolled and were randomly assigned to receive lactated Ringer's (LR) solution (n = 33) or NS (n = 33) in a double-blinded fashion. Anesthetic and fluid management were standardized. Multiple measures of outcome were monitored. The NS patients developed a hyperchloremic acidosis and received more bicarbonate therapy (30 +/- 62 mL in the NS group versus 4 +/- 16 mL in the LR group; mean +/- SD), which was given if the base deficit was greater than -5 mEq/L. The NS patients also received a larger volume of platelet transfusion (478 +/- 302 mL in the NS group versus 223 +/- 24 mL in the LR group; mean +/- SD). When all blood products were summed, the NS group received significantly more blood products (P = 0.02). There were no differences in duration of mechanical ventilation, intensive care unit stay, hospital stay, and incidence of complications. When NS was used as the primary intraoperative solution, significantly more acidosis was seen on completion of surgery. This acidosis resulted in no apparent change in outcome but required larger amounts of bicarbonate to achieve predetermined measurements of base deficit and was associated with the use of larger amounts of blood products. These changes should be considered when choosing fluids for surgical procedures involving extensive blood loss and requiring extensive fluid administration.
  
  
  CONCLUSIONS
  Predominant use of 0.9% saline solution in major surgery has little impact on outcome as assessed by duration of mechanical ventilation, intensive care unit stay, hospital stay, and postoperative complications, but it does appear to be associated with increased perioperative blood loss.
authors.affiliation: Department of General Anesthesiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. watersj@ccf.org
authors.forename: J H
authors.initials: JH
authors.lastname: Waters
authors.forename: A
authors.initials: A
authors.lastname: Gottlieb
authors.forename: P
authors.initials: P
authors.lastname: Schoenwald
authors.forename: M J
authors.initials: MJ
authors.lastname: Popovich
authors.forename: J
authors.initials: J
authors.lastname: Sprung
authors.forename: D R
authors.initials: DR
authors.lastname: Nelson
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001784:Blood Gas Analysis; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007432:Intraoperative Period; D007552:Isotonic Solutions; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D000077331:Ringer's Solution; D012965:Sodium Chloride; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
chemical_list: D007552:Isotonic Solutions; D012965:Sodium Chloride; D000077331:Ringer's Solution