Abstract
Background:Electrolyte imbalance and acute diabetes insipidus (DI) are the most common complications in patients undergoing craniopharyngioma surgery. Improper management of water and electrolyte imbalance is common cause of morbidity and mortality. Data is sparse and controversial regarding the choice of fluid therapy in this population during perioperative period.Methods:In this retrospective-prospective study involving 73 patients (58 retrospective), the type of fluid therapy was correlated with occurrence of hypernatremia, hyponatremia, DI, morbidity, and mortality. In the retrospective study, 48 patients received normal saline and 10 received mixed fluids as per the prevailing practice. In the prospective group, five patients each received normal saline, half normal saline, and 5% dextrose randomly.Results:The sodium values were significantly higher in first 48 h in the group that received normal saline compared with other groups (P < 0.001). The use of normal saline was associated with higher incidence of hypernatremia, DI, and mortality (P = 0.05), while the group that received 5% dextrose was associated with hyponatremia, hypoglycemia, and seizures. There was no perioperative hypotension with use of any of the fluids.Conclusion:Our results indicate half normal saline was fluid of choice with diminished incidence of water and electrolyte abnormalities without increase in mortality during postoperative period.
Highlights
Electrolyte imbalance and acute diabetes insipidus (DI) are the most common complications in patients undergoing craniopharyngioma surgery
Craniopharyngiomas are sellar and/or suprasellar and locally invasive tumors compressing critical neural and vascular structures. Surgery for these tumors may be challenging given the significant potential for harms with any intervention involving these critical structures and young age at presentation.[12,22]
Central DI is more likely if plasma osmolality is more than 300 osmol/kg and urine osmolarity less than 700 mosm/kg.[2,11]
Summary
In this retrospective-prospective study involving 73 patients (58 retrospective), the type of fluid therapy was correlated with occurrence of hypernatremia, hyponatremia, DI, morbidity, and mortality. All the hormonal parameters were done by immunochemiluminiscence method (COBAS 6001, Roche Diagnostic, Germany). Serum and urine sodium were measured by immunochemiluminiscence method (ELCYS 2010, Roche Diagnostic, Germany). The sample size of 5 per group was required to detect a difference of 10 mmol/L in serum sodium value with variance of 25. The alpha was set to 0.05 and adjusted for Bonferroni corrections for multiple comparisons. Parametric data was compared using analysis of variance and nonparametric data was done using Chi‐square test. Repeated measure data was analyzed with repeated measures of analysis of variance (ANOVA) (Friedman’s test for nonparametric data) with Bonferroni correction for comparison between groups. Proportional data was analyzed with Z test. Correlation of data was analyzed by Pearson’s or Spearman’s correlation based on the distribution of data
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