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Minerva Anestesiologica 2021 Oct 11

DOI: 10.23736/S0375-9393.21.15465-3


language: English

Electrolytes, albumin and acid base equilibrium during laparoscopic surgery

Giovanni SABBATINI 1, Alessio CACCIOPPOLA 1, 2, Andrea C. LUSARDI 1, 2, Tommaso POZZI 1, 2, Claudia BIANCO 1, Serena BAIO 1, Davide CHIUMELLO 1, 2, 3

1 Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy; 2 Department of Health Sciences, University of Milan, Milan, Italy; 3 Coordinated Research Center on Respiratory Failure, University of Milan, Milan, Italy

BACKGROUND: Surgery, causing inflammation, disrupts endothelial permeability leading to movement of fluids and albumin across the vascular barrier. Fluid therapy for restoring circulatory homeostasis may lead to positive fluid balance which has been shown to increase morbidity and mortality in surgical patients. The current investigation aims to describe physio-pathological changes in circulating albumin, fluid and electrolyte balance, and acidbase equilibrium in a cohort of patients undergoing laparoscopic surgery under general anesthesia.
METHODS: Single-center prospective observational study. Patients undergoing laparoscopic colorectal surgery were screened for eligibility.. Before surgery the baseline fasting conditions were homogenized. Hemoglobin, urinary and plasmatic were collected before surgery and then at pre-defined timepoints. Albumin/Creatinine ratio was measured before and after surgery. Expected and actual circulating Sodium concentrations were compared according to a physiological theoretical model. Assessment and quantification of changes in major electrolytes, albumin and acid-base balance was defined as the primary outcome of the study.
RESULTS: 38 patients were enrolled in the protocol. Patients had a positive electrolytes (Na+ 295 [244-375] mmol, Cl- 234 [195-295] mmol, K+ 16.8 [12.0-21.4] mmol) and fluid balance (2165 [1727-2728] ml). The positive fluid balance was associated with stable chloride (105 [103-107], end study vs 103 [102-106] mmol/L, baseline, p=ns) and potassium (4.2 [3.8-4.4], end study vs 4.1 [3.6-4.4] mmol/L, baseline, p=ns) levels, but sodium concentrations decreased over time (138 [137-140], end study vs 139 [138-141] mmol/L, baseline, p<0.05). The Albumin/Creatinine ratio was higher at the end of surgery 134 [61-267] vs 7 [4-14], p<0.001).
CONCLUSIONS: Data from patients undergoing colorectal laparoscopic surgery showed a positive fluid balance, decreased circulating albumin and increased albuminuria. A positive sodium balance was not always associated with an increase in sodium plasma concentration.

KEY WORDS: Aacid-base equilibrium; Electrolytes; Albumin; Fluid management; Fluid balance

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