title: Metabolic profile in right lobe living donor hepatectomy: Comparison of lactated Ringer's solution and normal saline versus acetate based balanced salt solution - a pilot study.
abstract: OBJECTIVE
  Lactate levels predict outcomes after hepatectomy. We compared metabolic effects of lactated versus lactate free solutions in living donor hepatectomy.
  
  
  METHODS
  Consecutive right lobe donors (n= 53) were alternatively allotted to lactated Ringer's solution and normal saline (Group L-control) or acetated crystalloid (Sterofundin B Braun®Group S -study group) in an observational prospective randomised study. The primary outcome measure was lactate level, and secondary outcomes were base excess, bicarbonate, glucose and chloride intra- and post-operatively. Mann-Whitney and Chi-square tests were used for analysis.
  
  
  RESULTS
  The intraoperative, post-operative lactate levels and the time for normalisation were comparable. Group L had significantly lower intraoperative bicarbonate levels (mmol/L) at 6 and 8 h (20.0 ± 2.14 vs. 21.3 ± 1.6,P= 0.0471; 18.68 ± 2.04 vs. 20.39 ± 17,P= 0.002), base excess at 4 and 6 h (mmol/L) (-3.64 ± 2.73 vs. -3.0 ± 1.52,P= 0.031; -6.64 ± 2.76 vs. -4.35 ± 1.7P= 0.006). The intraoperative chloride levels (mmol/L) were higher in group L at 4 and 8 h (108 ± 5.9 vs. 105.99 ± 2.76,P= 0.0471; 109.51 ± 3.86 vs. 106.93 ± 3.09,P= 0.002). Intraoperative glucose (mg/dL) at 6 h was higher in group L, 160.55 ± 31.52 vs. 145.5 ± 24.29,P= 0.043. The highest post-operative chloride (mmol/L) was higher in Group L (112.3 ± 3.86 vs. 109.81 ± 3.72,P= 0.034). Post-operative base excess and bicarbonate showed an improved profile in Group S (-7.37 ± 2.99 vs. -5.06 ± 1.71P= 0.001 and 17.79 ± 2.23 vs. 19.68 ± 1.51P= 0.005).
  
  
  CONCLUSIONS
  Acetated fluids were associated with higher levels of bicarbonate, lesser base deficit, glucose and chloride but no difference in lactate levels in comparison with Ringer's lactate and normal saline in living donor hepatectomy.
authors.affiliation: Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Kumar
authors.affiliation: Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
authors.forename: Murukesh
authors.initials: M
authors.lastname: Seetharaman
authors.affiliation: Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
authors.forename: Nisha
authors.initials: N
authors.lastname: Rajmohan
authors.affiliation: Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
authors.forename: Pavithra
authors.initials: P
authors.lastname: Ramamurthi
authors.affiliation: Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Rajan
authors.affiliation: Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
authors.forename: Rekha
authors.initials: R
authors.lastname: Varghese
keywords: Acetate; Ringer's lactate; balanced salt solution; hepatectomy