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Online ISSN 1827-1596
Weinberg L. 1, 2, 3, Pearce B. 1, Sullivan R. 4, Siu L. 5, Scurrah N. 1, Tan C. 1, Backstrom M. 5, Nikfarjam M. 2, McNicol L. 1, Story D. 2, Christophi C. 2, Bellomo R. 6
1 Department of Anesthesia, Austin Hospital, Heidelberg, Victoria, Australia;
2 Department of Surgery, Melbourne Medical School, The University Melbourne, Melbourne, Victoria, Australia;
3 Perioperative and Pain Medicine Unit, Melbourne Medical School, The University Melbourne, Melbourne, Victoria, Australia;
4 Department of Anesthesia, Peter McCallum Cancer Centre, East Melbourne, Victoria, Australia;
5 Department of Anesthesia, Monash Medical Centre, Clayton, Victoria, Australia;
6 Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
BACKGROUND: The acid-base, biochemical and hematological effects of crystalloid solutions have not been comprehensively evaluated in patients with liver resection.
METHODS: Design: 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. Primary outcome: base excess immediately after surgery. Secondary outcomes: 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).
CONCLUSION: 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.