The effect of 0.9% saline versus plasmalyte on coagulation in patients undergoing lumbar spinal surgery; a randomized controlled trial

Jong Wook Song, Jae Kwang Shim, Na Young Kim, Jaewon Jang, Younglan Kwak

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Introduction: In multi-level lumbar spinal fusion surgery yielding a large amount of blood loss, choice of fluid for volume resuscitation is an important issue since it can influence acid-base status, coagulation, and patients' outcome. This study compared the effect of plasmalyte to 0.9% saline on coagulation assessed by rotation thromboelastometry (ROTEM) and acid-base balance in the aforementioned patients. Methods: Fifty patients were randomly allocated to receive either 0.9% saline or plasmalyte during operation and until postoperative 12 h. ROTEM was performed at 10 min after anesthetic induction and end of surgery. Arterial blood gas analyses were serially performed from 10 min after anesthetic induction until postoperative 12 h. Fluid balance, blood loss, and transfusion requirement were assessed. Results: ROTEM variables showed sporadic deterioration in both groups after surgery without intergroup differences. Intraoperatively, arterial pH, base excess, and bicarbonate concentrations were lower and serum chloride concentrations were higher in the 0.9% saline group compared with the plasmalyte group. The differences in base excess and bicarbonate concentrations persisted until postoperative 12 h. Fluid balance, blood loss, and transfusion requirement were similar between the groups while urine output was greater in the plasmalyte group compared with the 0.9% saline group (3.2 ± 1.6 ml/kg/h vs. 1.8 ± 1.1 ml/kg/h, p = 0.001). Conclusion: In contrast to plasmalyte, fluid therapy with 0.9% saline resulted in transient hyperchloremic acidosis in patients undergoing multi-level lumbar spinal fusion, while coagulation assessed by ROTEM analysis and the amount of blood loss were similar between the groups.

Original languageEnglish
Pages (from-to)128-134
Number of pages7
JournalInternational Journal of Surgery
Volume20
DOIs
Publication statusPublished - 2015 Aug 1

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Thrombelastography
Randomized Controlled Trials
Spinal Fusion
Water-Electrolyte Balance
Bicarbonates
Blood Transfusion
Anesthetics
Blood Gas Analysis
Acid-Base Equilibrium
Fluid Therapy
Acidosis
Resuscitation
Chlorides
Urine
Acids
Serum

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

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title = "The effect of 0.9{\%} saline versus plasmalyte on coagulation in patients undergoing lumbar spinal surgery; a randomized controlled trial",
abstract = "Introduction: In multi-level lumbar spinal fusion surgery yielding a large amount of blood loss, choice of fluid for volume resuscitation is an important issue since it can influence acid-base status, coagulation, and patients' outcome. This study compared the effect of plasmalyte to 0.9{\%} saline on coagulation assessed by rotation thromboelastometry (ROTEM) and acid-base balance in the aforementioned patients. Methods: Fifty patients were randomly allocated to receive either 0.9{\%} saline or plasmalyte during operation and until postoperative 12 h. ROTEM was performed at 10 min after anesthetic induction and end of surgery. Arterial blood gas analyses were serially performed from 10 min after anesthetic induction until postoperative 12 h. Fluid balance, blood loss, and transfusion requirement were assessed. Results: ROTEM variables showed sporadic deterioration in both groups after surgery without intergroup differences. Intraoperatively, arterial pH, base excess, and bicarbonate concentrations were lower and serum chloride concentrations were higher in the 0.9{\%} saline group compared with the plasmalyte group. The differences in base excess and bicarbonate concentrations persisted until postoperative 12 h. Fluid balance, blood loss, and transfusion requirement were similar between the groups while urine output was greater in the plasmalyte group compared with the 0.9{\%} saline group (3.2 ± 1.6 ml/kg/h vs. 1.8 ± 1.1 ml/kg/h, p = 0.001). Conclusion: In contrast to plasmalyte, fluid therapy with 0.9{\%} saline resulted in transient hyperchloremic acidosis in patients undergoing multi-level lumbar spinal fusion, while coagulation assessed by ROTEM analysis and the amount of blood loss were similar between the groups.",
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The effect of 0.9% saline versus plasmalyte on coagulation in patients undergoing lumbar spinal surgery; a randomized controlled trial. / Song, Jong Wook; Shim, Jae Kwang; Kim, Na Young; Jang, Jaewon; Kwak, Younglan.

In: International Journal of Surgery, Vol. 20, 01.08.2015, p. 128-134.

Research output: Contribution to journalArticle

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T1 - The effect of 0.9% saline versus plasmalyte on coagulation in patients undergoing lumbar spinal surgery; a randomized controlled trial

AU - Song, Jong Wook

AU - Shim, Jae Kwang

AU - Kim, Na Young

AU - Jang, Jaewon

AU - Kwak, Younglan

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N2 - Introduction: In multi-level lumbar spinal fusion surgery yielding a large amount of blood loss, choice of fluid for volume resuscitation is an important issue since it can influence acid-base status, coagulation, and patients' outcome. This study compared the effect of plasmalyte to 0.9% saline on coagulation assessed by rotation thromboelastometry (ROTEM) and acid-base balance in the aforementioned patients. Methods: Fifty patients were randomly allocated to receive either 0.9% saline or plasmalyte during operation and until postoperative 12 h. ROTEM was performed at 10 min after anesthetic induction and end of surgery. Arterial blood gas analyses were serially performed from 10 min after anesthetic induction until postoperative 12 h. Fluid balance, blood loss, and transfusion requirement were assessed. Results: ROTEM variables showed sporadic deterioration in both groups after surgery without intergroup differences. Intraoperatively, arterial pH, base excess, and bicarbonate concentrations were lower and serum chloride concentrations were higher in the 0.9% saline group compared with the plasmalyte group. The differences in base excess and bicarbonate concentrations persisted until postoperative 12 h. Fluid balance, blood loss, and transfusion requirement were similar between the groups while urine output was greater in the plasmalyte group compared with the 0.9% saline group (3.2 ± 1.6 ml/kg/h vs. 1.8 ± 1.1 ml/kg/h, p = 0.001). Conclusion: In contrast to plasmalyte, fluid therapy with 0.9% saline resulted in transient hyperchloremic acidosis in patients undergoing multi-level lumbar spinal fusion, while coagulation assessed by ROTEM analysis and the amount of blood loss were similar between the groups.

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