Clearance Rates of Ringer's Lactate and Adept and the Effect of Full Conditioning: A Randomized Controlled Trial

Abstract

Background: Instillation of crystalloid flotation agents, such as Ringer's lactate has been suggested for preventing adhesion formation after abdominal surgery, but the efficacy of this approach remains controversial. Objective: The aim of this pilot study was to evaluate the resorption rates of Ringer's lactate and icodextrin 4% following a pneumoperitoneum with CO2 and humidification (control) in comparison with a pneumoperitoneum with 86%CO2+10%N2O+4%O2 together with cooling and humidification (full conditioning). Materials and Methods: Twenty women undergoing laparoscopic hysterectomy were prospectively randomized to have during surgery with a control or a full-conditioned pneumoperitoneum as well as the instillation of 1000 mL of Ringer's lactate or icodextrin 4% at the end of surgery. Fluid volumes remaining after 24, 48, and 72 hours were measured by ultrasound testing. Results: The peritoneal volumes of Ringer's lactate and icodextrin 4% both decreased exponentially over time. Following a pneumoperitoneum with CO2, the resorption rate of Ringer's lactate was faster than for icodextrin 4%. After 24, 48, and 72 hours 11.7±1.0% versus 38.2±9.5% (p=0.009), 5.3±0.6% versus 14.9±4.8% (NS), and 4.2±0.7% versus 12.1±4% (p=0.03), respectively of the initial 1 L remained. Conditioning decreased the resorption rate of Ringer's lactate and after 24, 48, and 72 hours 25.2±3.4, 13.2±1.3 and 6.0±0.5% remained (p=0.03, 0.009, and NS versus the control group), respectively Conditioning did not affect the resorption rate of icodextrin. Conclusions: The absorption of both Ringer's lactate and of icodextrin 4% from the peritoneal cavity was fast and exponential in this pilot study. In the control group, the resorption rate of icodextrin 4% was slightly slower than that of Ringer's lactate. After conditioning, the resorption rate of Ringer's was slower and became comparable to that of icodextrin 4%. (J GYNECOL SURG 31:139)