title: The effects of plasmalyte-148 vs. Hartmann's solution during major liver resection: a multicentre, double-blind, randomized controlled trial.
abstract: BACKGROUND
  The acid-base, biochemical and hematological effects of crystalloid solutions have not been comprehensively evaluated in patients with liver resection.
  
  
  METHODS
  
  
  
  METHODS
  multicenter, prospective, double-blind randomized controlled trial investigating the biochemical effects of Hartmann's solution (HS) or Plasmalyte-148 (PL) in 60 patients undergoing major liver resection.
  
  
  METHODS
  base excess immediately after surgery.
  
  
  RESULTS
  changes in blood biochemistry and hematology.
  
  
  RESULTS
  At completion of surgery, patients receiving HS had equivalent mean standard base excess (-1.7±2.2 vs. -0.9±2.3 meq/L; P=0.17) to those treated with PL. However, patients treated with HS were more hyperchloremic (difference 1.7 mmol/L, 95% CI: 0.2 to 3.2, P=0.03) and hyperlactatemic (difference 0.8 mmol/L, 95% CI: 0.2 to 1.3; P=0.01). In contrast, patients receiving PL had higher mean plasma magnesium levels and lower ionized calcium levels. There were no significant differences in pH, bicarbonate, albumin and phosphate levels. Immediately after surgery, mean PT and aPTT were significantly lower in the PL group. Intraoperatively, the median (IQR) blood loss in the PL group was 300 mL (200:413) vs. 500 mL (300:638) in the HS group (P=0.03). Correspondingly, the postoperative hemoglobin was higher in the PL group. Total complications were more frequent in the HS Group (56% vs. 20%, relative risk 2.8; 95% CI: 1.3 to 6.1; P=0.007).
  
  
  CONCLUSIONS
  In liver resection patients, HS and PL led to similar base excess values but different post operative plasma biochemistry and hematology values. Understanding of these effects may help clinicians individualize fluid therapy in these patients.
authors.affiliation: Department of Anesthesia, Austin Hospital, Heidelberg, Victoria, Australia - laurence.weinberg@austin.org.au.
authors.forename: L
authors.initials: L
authors.lastname: Weinberg
authors.forename: B
authors.initials: B
authors.lastname: Pearce
authors.forename: R
authors.initials: R
authors.lastname: Sullivan
authors.forename: L
authors.initials: L
authors.lastname: Siu
authors.forename: N
authors.initials: N
authors.lastname: Scurrah
authors.forename: C
authors.initials: C
authors.lastname: Tan
authors.forename: M
authors.initials: M
authors.lastname: Backstrom
authors.forename: M
authors.initials: M
authors.lastname: Nikfarjam
authors.forename: L
authors.initials: L
authors.lastname: McNicol
authors.forename: D
authors.initials: D
authors.lastname: Story
authors.forename: C
authors.initials: C
authors.lastname: Christophi
authors.forename: R
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004311:Double-Blind Method; D005260:Female; D005942:Gluconates / Q000627:therapeutic use; D006498:Hepatectomy; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use*; D008099:Liver / Q000601:surgery*; D015636:Magnesium Chloride / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000097:blood; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011189:Potassium Chloride / Q000627:therapeutic use; D011446:Prospective Studies; D000077325:Ringer's Lactate; D019346:Sodium Acetate / Q000627:therapeutic use; D012965:Sodium Chloride / Q000627:therapeutic use; D014882:Water-Electrolyte Balance / Q000187:drug effects
chemical_list: D005942:Gluconates; D007552:Isotonic Solutions; D008903:Minerals; D010952:Plasma Substitutes; C012499:Plasma-lyte 148; D000077325:Ringer's Lactate; D015636:Magnesium Chloride; D012965:Sodium Chloride; D019346:Sodium Acetate; D011189:Potassium Chloride