Influence of 3% Hypertonic Saline Versus 0.9% Saline on Intraoperative Maintenance Fluid Requirements in Adult Patients Undergoing Major Open Abdominal Surgeries: Randomized Controlled Study.

Abstract

Three percent hypertonic saline (3% HTS) acts like an osmotic buffer and draws fluid from the extracellular space into the intravascular compartment. Primary objective was to evaluate whether use of 3% HTS resulted in a difference in intraoperative maintenance fluid requirement versus 0.9% saline (NS). Secondary objectives were to evaluate differences in 24h fluid requirements and safety of 3% HTS. Adult patients of either sex, 18-65years, undergoing elective major open abdominal surgeries were randomized to receive infusions of 3% HTS or NS at 1ml/kg/hr through large bore peripheral i.v cannulas, or central venous catheters after anesthesia induction. Intraoperative maintenance fluids were administered to maintain mean arterial pressure (≥70mmHg), urine output (≥0.5ml/kg/hr) and central venous pressure of 8-10cm H2O. Ninety-three patients completed the study (46 in 3% HTS and 47 in NS group). No difference was seen in the volume of intraoperative maintenance fluids (3% HTS vs NS; 2243.9 ± 896.7ml vs 2093.6 ± 868.7ml; P = 0.34). Similarly, the 24h postoperative fluid requirement was not different (3% HTS vs NS; 2006.6 ± 398.6ml vs 2018.3 ± 389.3ml; P = 0.94). Patients in 3% HTS group had statistically but not clinically significant higher serum sodium values at postoperative 12th and 24h. No complication like thrombophlebitis or tissue ischemia was reported due to administration of 3% HTS through peripheral lines. Administration of 3% HTS did not reduce intraoperative maintenance fluid requirements in patients undergoing major open abdominal surgeries. CTRI/2019/09/021032.