Comparative study of effect of intra-operative administration of ringer’s lactate, sterofundin, plasmalyte-A and kabilyte on ionic and acid base status
Journal Title: Medpulse International Journal of Anesthesiology - Year 2017, Vol 4, Issue 3
Abstract
Aim: The aim of the study was to compare the effect of intra-operative administration of RL, sterofundin, plasmalyte-A and kabilyte on ionic and acid base status. Materials and Methods: This study was a prospective Monocentric Double blinded Randomised controlled trial conducted for 1 year during the period of February 2015 to February 2016. 80 patients undergoing surgery for less than 3 hours (surface surgeries of limited duration and minimal blood loss ) under general anaesthesia were divided into 4 groups of 20 each randomly. 20 were assigned to each of the four groups to receive lactated ringer’s solution (Group C), sterofundin (Group S), plasmalyte (Group P) and kabilyte (Group K) respectively. Results: No biologically significant inter-group differences were observed in the patient demographics. Intergroup comparison of baseline serum urea, serum creatinine and haemodynamic parameters revealed no statistically significant difference. Intergroup comparison of ABG parameters- pH, partial pressure of oxygen, partial pressure of carbon-di-oxide, lactate, glucose, potassium, calcium, chloride, sodium, bicarbonate, base deficit, anion gap and osmolality were studied at baseline, 1 hour, end of surgery and post-op (1 hour after extubation) and Haemodynamic parameters-heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, SPV, dPP were studied at baseline and15,30,45,60,75,90,105, 120 mins post induction. Though our main aim was only to study the effect of administering these four different intra venous crystalloids on ionic and acid base status haemodynamic parameters were studied with our assumption to show that they are comparable across the groups and do not contribute to the changes in acid base and ionic status. Intergroup comparison of ABG parameters revealed no statistically significant difference except for PaO2 measured one hour postoperatively (p=0.016), calcium measured at the end of surgery ( p=0.022) and calcium measured one hour postoperatively (p=0.002). Intergroup comparision of all the other ABG parameters revealed no statistically significant difference between the groups at different time points (baseline, 1hour, end of surgery, 1hour post-op). However significant within group difference was observed for some parameters at some time points compared with baseline. Intergroup comparison of haemodynamic parameters revealed a statistically comparable trend at all times( p> 0.05) except the heart rates 15 and 30 minutes post induction ( p= 0.028 and 0.041 respectively),MAP recordings at 15 minutes post induction(p=0.022) and SPV recordings at 45 (p=0.012), 60(p=0.007), 75(p=0.034) and 120(p=0.044) minutes post induction. All these statistically significant inter group changes in haemodynamic parameters were observed in the sterofundin group (S) compared with Ringer’s lactatae/control group (C). No statistically significant inter group difference was found in SBP, DBP and dPP measurements at any time of study. Conclusion: The use of balanced salt solutions in surface surgeries of limited duration and minimal blood loss is associated with stable ionic and acid- base profile and is not associated with significant advantage over Lactated Ringer’s solution. All the three balanced salt solutions used in our study i.e., plasmalyte-A, sterofundin and kabilyte gave similar outcomes with respect to electrolyte and acid-base status when compared with one another.
Authors and Affiliations
Anne Kiran Kumar, A Chaitanya Pratyusha, J Kavitha, Gopinath Ramachandran
Keywords
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