Ringer's Acetate Research Articles

Impact of resuscitation fluid bag size availability on volume of fluid administration in the intensive care unit.

Iatrogenic fluid overload is associated with increased mortality in the intensive care unit (ICU). Decisions on fluid therapy may, at times, be based on other factors than physiological endpoints. We hypothesized that because of psychological factors volume of available fluid bags would affect the amount of resuscitation fluid administered to ICU patients. We performed a prospective intervention cross-over study at 3 Swedish ICUs by replacing the standard resuscitation fluid bag of Ringer's Acetate 1000mL with 500mL bags (intervention group) for 5 separate months and then compared it with the standard bag size for 5months (control group). Primary endpoint was the amount of Ringer's Acetate per patient during ICU stay. Secondary endpoints were differences between the groups in cumulative fluid balance and change in body weight, hemoglobin and creatinine levels, urine output, acute kidney failure (measured as the need for renal replacement therapy, RRT) and 90-day mortality. Six hundred and thirty-five ICU patients were included (291 in the intervention group, 344 in the control group). There was no difference in the amount of resuscitation fluid per patient during the ICU stay (2200mL [1000-4500 median IQR] vs 2245mL [1000-5630 median IQR]), RRT rate (11 vs 9%), 90-day mortality (11 vs 10%) or total fluid balance between the groups. The daily amount of Ringer's acetate administered per day was lower in the intervention group (1040 (280-2000) vs 1520 (460-3000) mL; P=.03). The amount of resuscitation fluid administered to ICU patients was not affected by the size of the available fluid bags. However, altering fluid bag size could have influenced fluid prescription behavior.

Pre-operative fluid bolus for improved haemodynamic stability during minor surgery: A prospectively randomized clinical trial.

Haemodynamic instability during the induction of anaesthesia and surgery is common and may be related to hypovolaemia caused by pre-operative fasting or chronic diuretic therapy. The aim of our prospective, controlled, randomized study was to test the hypothesis that a predefined fluid bolus given prior to general anaesthesia for minor surgery would increase haemodynamic stability during anaesthetic induction. Two hundred and nineteen fairly healthy adult patients requiring minor surgery were enrolled. All received standard treatment, including a pulse contour analysing device for non-invasive measurement of cardiac index. Infusion therapy was started in all patients at induction. The intervention group (106 patients) was randomized to receive an additional fluid bolus of 8mL/kg Ringer's acetate solution before the induction of anaesthesia. The primary endpoint was the incidence of haemodynamic instability, defined as a significant reduction of blood pressure or cardiac index during induction of anaesthesia. The interventional group had a lesser incidence of haemodynamic instability during induction (41.5% vs 56.6%, P=.025). This group also had higher cardiac index, stroke volume index, systolic and mean blood pressure and a greater left ventricular end-diastolic area. A fluid bolus prior to anaesthesia reduced the incidence of haemodynamic instability during induction of general anaesthesia. The total fluid volume was slightly greater in the intervention group compared to the control group (1370±439mL vs 1219±483mL, P=.007). We conclude that a defined fluid bolus can help stabilizing haemodynamics in patients undergoing general anaesthesia.

Stability of benzylpenicillin potassium and ampicillin in an elastomeric infusion pump.

Some infectious diseases, such as infective endocarditis, osteomyelitis, and abscesses, require treatment with long-term intravenous antimicrobial treatment. Therefore, the patient is required to stay in the hospital to receive therapy, which lowers their quality of life. Establishing an outpatient parenteral antimicrobial therapy (OPAT) by continuous infusion pump is desired in Japan to overcome these issues. However, the 24-h stability of antimicrobial agents dissolved in infusion solutions is unclear. Thus, we investigated the stability of antimicrobial agents in five different infusion solutions in a clinical setting. Benzylpenicillin potassium (PCG) and ampicillin (ABPC) were dissolved separately in five different infusion solutions and kept at 25 or 31.1°C for 24h. The residual ratios were determined by high-performance liquid chromatography (HPLC). Dissolved PCG in acetate ringer solution remained stable for 24h at temperatures of 25 and 31.1°C (101.7±1.4% and 92.9±1.3%, respectively). In addition, the PCG solution did not adsorb onto the elastomeric infusion pump after 24h at 31.1°C. PCG dissolved in acetate ringer solution was also stable for 10 days after being kept in an elastomeric infusion pump at 4°C (99.7±0.5%). ABPC was unstable in all of the tested infusion solutions and temperatures. Based on our results, PCG in acetate ringer solution can be used in OPAT with continuous infusion pumps.

Internal jugular vein distensibility in assessment of fluid responsiveness in donors of living donor liver transplantation

BackgroundThe concept of brain death is still not acceptable nor implemented in Egypt. Donor safety in liver transplantation is on the top of our priorities.PurposeThe purpose of this study is to evaluate the effectiveness of using IJV distensibility as a reliable method for intraoperative assessment of fluid responsiveness.MethodsA prospective observational study was conducted in Ain Shams university specialized hospitals. 40 donor candidates for right lobe hepatectomy for living donor liver transplantation were enrolled. During period of hypovolemia (T0) left IJV scanned and measured. After a given fluid bolus in the form of ringer acetate 5 ml/kg. ultrasonic and hemodynamic measurements were reassessed 10 min (T 10) after the fluid resuscitation.ResultsHighly significant changes in MABP, HR, and CVP (p < 0.01) were detected after fluid resuscitation, regarding the IJV distensibility it showed a highly significant reduction from baseline (T0) to post-resuscitation expansion (P = 0.0001). Baseline (T0) measurements showed no significant correlation between IJV distensibility and hemodynamic parameters (P ≥ 0.05). Post-resuscitation values (T10) showed no significance correlation between HR and IJV distensibility (P = 0.772). On the other side it showed a highly significance negative correlation between MABP, CVP and IJV distensibility (r = −0.390, P = 0.013) and (r = −0.332∗, p = 0.036) respectively. The correlation between the percentages of change of IJV distensibility and hemodynamic parameters showed highly significant negative correlation between IJV distensibility and MABP (r = −0.359, P = 0.023) also with CVP (r = −0.464, P = 0.017). No difference was found regarding the HR (P = 0.336).ConclusionOrgan transplantation centers with experience, CVP monitoring may not be necessary in highly selective patient population. IJV distensibility, a non-invasive and safe method can be used to guide fluid replacement in healthy donor.

Pyruvate as a novel carrier of hydroxyethyl starch 130/0.4 may protect kidney in rats subjected to severe burns

BackgroundThe carrier of hydroxyethyl starch (HES) may play a critical role in kidney injury in fluid resuscitation. This study aimed mainly to compare effects of pyruvate-enriched saline with normal saline (NS) and acetate Ringer's (AR) solution as a carrier in HES130/0.4 on kidney function in rats subjected to severe burns. MethodsUsing a lethal burn model, 140 rats were randomly allocated in seven groups (n = 20): sham group (group S); no fluid after burn (group N); burn resuscitated with NS (group NS); burn resuscitated with pyruvate saline (group PS); burn resuscitated with AR plus pyruvate-HES (group SP); burn resuscitated with AR plus acetate-HES (group SA), and burn resuscitated with AR plus NS-HES (group SN). A low volume (18.75 mL·kg−1 during 12 h) of HES130/0.4 was infused with the ratio of 1:1 to crystalloids. Renal surface blood flow, blood creatinine and blood urea nitrogen, early sensitive indicators of kidney function: alpha-1 microglobulin, cystatin-C, and neutrophil gelatinase–associated lipocalin in blood and urine, and kidney tissue water contents were determined. Renal histopathological alterations with Paller scores were also measured at 8 h and 24 h after burn (n = 10), respectively. ResultsThe results showed in a comparable manner that group SP was the best in three HES groups and group PS was superior to group NS in renal preservation; group SP appeared significantly beneficial compared with group PS in renal surface blood flow, cystatin-C, neutrophil gelatinase-associated lipocalin, water contents, and Paller scores at 8-h or both time points after burn, respectively (all P < 0.05). ConclusionsThe carrier of HES130/0.4 played a crucial role in kidney injury in fluid resuscitation of rats subjected to severe burns. Pyruvate-enriched HES130/0.4 was superior and HES130/0.4, per se, might be not renocytotoxic, but renoprotective. Further studies are warranted.

Effect of combinations of intravenous small-volume hypertonic sodium chloride, acetate Ringer, sodium bicarbonate, and lactate Ringer solutions along with oral fluid on the treatment of calf diarrhea

The aim of this study was to compare effect of combinations of intravenous isotonic sodium bicarbonate (NaHCO3), acetate Ringer, lactate Ringer and small-volume hypertonic sodium chloride (NaCI) solutions along with oral electrolyte solutions (OES) on the treatment of neonatal calf diarrhea with moderate dehydration and metabolic acidosis. Thirty-two calves with diarrhea were used in the study. Calves were randomly assigned to receive acetate Ringer solution (n=8), lactate Ringer solution (n=8), isotonic NaHCO3 (n=8) and 7.2% saline solutions (n=8), and two liters of OES were administrated to all calves orally at the end of intravenous administration. Blood samples for blood gas and biochemical analyses were collected at 0 hours and at 0.5, 1, 2, 4, 6 and 24 hours intervals. All the calves had mild to moderate metabolic acidosis on admission. Increased plasma volume and sodium concentration, but decreased serum total protein were observed within 0.5 hours following administration of hypertonic 7.2% NaCI + OES, compared to other 3 groups. In conclusion, administration of intravenous hypertonic 7.2% NaCI solution in small volume along with OES provided fast and effective improvement of dehydration and acid-base abnormalities within short time in treatment of calf diarrhea with moderate dehydration and metabolic acidosis.

Expert consensus on the clinical application of sodium acetate ringer's perioperative period

Expert consensus on the clinical application of sodium acetate ringer's perioperative period

Research Article The effect of acetate Ringer's solution on inflammatory factors and NF-κB signal pathway in the liver of hemorrhagic shock rats

Purpose: To investigate the effect of resuscitation with acetated Ringer's solution during hemorrhagic shock (HS) on inflammatory factors and nuclear factor κB (NF-κB) signaling pathway in liver tissue. Methods: In this study, a rat HS model was established. HS rats received acetated Ringer's solution, lactated Ringer's solution and saline for fluid resuscitation. Inflammatory factors (TNF-α, IL-4 and IL-10) for the evaluation of three kinds of resuscitation mfluid anti-inflammatory effect. Expression of proteins in NF-κB pathway was evaluated to elucidate the mechanism of acetated Ringer's solution in preventing HS-induced liver injury. Results: Although HS upregulated inflammatory response in liver tissue, acetated Ringer's solution t-treatment can inhibit the inflammation and improve liver injury. We also found that acetated ringer’s solution treatment attenuated HS-induced liver injury in NF-κB pathway. Conclusion: Acetated Ringer's solution may improve HS-induced liver injury. The mechanism of its action may be by inhibiting the NF-κB pathway.

Evaluation of the Metabolic Profile of Ringer Lactate versus Ringer Acetate in Nondiabetic Patients Undergoing Major Surgeries.

Background:Stress-induced neuroendocrine and metabolic changes lead to intraoperative hyperglycemia which is related to surgery and the type of intravenous fluids used.Aims:The primary objective was to assess the incidence of hyperglycemia with use of lactate versus acetate-based intravenous fluids in nondiabetics undergoing major surgeries. Incidence of lactatemia and metabolic acidosis were also assessed.Settings and Design:Prospective parallel group observational study conducted in a tertiary care institute.Subjects and Methods:A total of 208 nondiabetic patients undergoing major head and neck free flap or abdominal surgeries were included in the study. Group A received Ringer lactate, and Group B received Ringer acetate as intraoperative maintenance fluid. Intraoperative blood sugar, pH, and lactate levels were monitored.Statistical Tests Used:Chi-square test and independent “t” test were used for analysis.Results:Intraoperative hyperglycemia was more frequent in Group A than B (17.3 vs. 18.4%). Group B patients undergoing gastrointestinal (GI) surgeries showed higher blood glucose at 2, 4, 6, and 8 h when compared to flap surgeries. In Group A, significantly higher blood sugar values were noted at 2 and 8 h in those undergoing GI surgeries. Group B patients undergoing GI surgeries had significantly higher lactate levels at 6 and 8 h. Group B patients had significant acidosis when surgeries lasted >6 h.Conclusion:Nondiabetic patients undergoing major abdominal surgeries who received acetate-based fluids had relatively higher intraoperative blood sugar levels as compared to those receiving lactated solutions, but the incidence of hyperglycemia was comparable. When the duration of surgery exceeded 6 h, acetate-based solutions resulted in significantly higher lactate levels with progressive metabolic acidosis.

Reply: Blood Congestion Can Be Rescued by Hemodilution in a Random-Pattern Skin Flap.

Sir: We are grateful to Di Lorenzo et al. for their interest in our study.1 Prevention of flap necrosis is an important subject for every plastic surgeon. Our study results indicated the potential therapeutic value of perioperative hemodilution for a better survival rate of random pattern areas of any types of skin flap. The main reason for necrosis of random pattern areas is not ischemia, but venous congestion, which can be partly improved by hemodilution. Di Lorenzo et al. described that they use hemodilution with saline containing a proton-pump inhibitor, an antiplatelet drug, and prednisolone 12 hours before microsurgical flap transfer to seek better flap survival. Although preoperative hemodilution protocols are not yet standardized, we agree with their idea regarding the importance and potential benefits of perioperative systemic conditioning, including hemodilution. We do yet not routinely use intentional preoperative hemodilution but believe that the clinical application of the theory is promising and that further studies are needed to verify and establish a standard protocol. What we currently apply hemodilution for is to avoid unnecessary blood transfusion and infuse crystalloids or colloids for recovering the loss of plasma volume during or after flap surgery. As for their concern about the use of colloids, we usually use a combination of crystalloids and colloids for hemorrhage or hypovolemia unless blood products are required. There is controversy regarding crystalloids versus colloids and which one is more effective and safer for maintaining plasma volume in shock patients. A multicenter, randomized, controlled study showed that patients with severe sepsis receiving hydroxyethyl starch had an increased risk of death on day 90 and were more likely to require renal-replacement therapy compared with those receiving Ringer acetate.2 In contrast, a systematic review researching 59 articles concluded that the current general restrictions on the use of colloids for volume replacement are not supported by scientific evidence.3 They also indicated that acute kidney injury was significantly reduced by colloid therapy compared with crystalloid therapy in patients with traumatic injuries.3 Circulatory shock, a critical low blood perfusion to tissues, is classified into four main types based on underlying cause: hypovolemic (such as hemorrhage), cardiogenic, distributive (such as sepsis), and obstructive. We believe that colloid therapy is more effective for acute hemorrhagic shock compared with crystalloid therapy, although it may be harmful for septic shock without loss of colloids because kidneys can be damaged by colloid overload. In addition, adverse effects of hydroxyethyl starch such as acute renal failure seem to correlate to its molecular weight. Hydroxyethyl starch 70/0.5 (Salinhes; Fresenius Kabi Japan, Tokyo, Japan), very low-molecular-weight hydroxyethyl starch, is considered less harmful than hydroxyethyl starch 130/0.4 (Voluven; Fresenius Kabi, Bad Homburg, Germany) or hydroxyethyl starch 130/0.42 (Tetraspan; B. Braun, Melsungen, Germany), low-molecular-weight hydroxyethyl starch used in European countries. It was indicated that hydroxyethyl starch 70/0.5, but not Ringer acetate, increased the hepatic blood flow, suggesting that it is also effective for promoting flap circulation.4 Thus, we regard the low-molecular-weight hydroxyethyl starch as an appropriate solution used in flap surgery unless patients have serious risks such as renal dysfunction or disorder of blood coagulation. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Koji Kanayama, M.D.Takanobu Mashiko, M.D.Department of Plastic SurgeryJichi Medical UniversityTochigi, JapanDepartment of Plastic SurgeryUniversity of Tokyo School of MedicineTokyo, Japan Rintaro Asahi, M.D.Ataru Sunaga, M.D.Kotaro Yoshimura, M.D.Department of Plastic SurgeryJichi Medical UniversityTochigi, Japan

Better platelet function, less fibrinolysis and less hemolysis in re-transfused residual pump blood with the Ringer’s chase technique – a randomized pilot study

Residual pump blood from the cardiopulmonary bypass (CPB) circuit is often collected into an infusion bag (IB) and re-transfused. An alternative is to chase the residual blood into the circulation through the arterial cannula with Ringer's acetate. Our aim was to assess possible differences in hemostatic blood quality between these two techniques. Forty adult patients undergoing elective coronary artery bypass graft surgery with CPB were randomized to receive the residual pump blood by either an IB or through the Ringer's chase (RC) technique. Platelet activation and function (impedance aggregometry), coagulation and hemolysis variables were assessed in the re-transfused blood and in the patients before, during and after surgery. Results are presented as median (25-75 quartiles). Total hemoglobin and platelet levels in the re-transfused blood were comparable with the two methods, as were soluble platelet activation markers P-selectin and soluble glycoprotein VI (GPVI). Platelet aggregation (U) in the IB blood was significantly lower compared to the RC blood, with the agonists adenosine diphosphate (ADP) 24 (10-32) vs 46 (33-65), p<0.01, thrombin receptor activating peptide (TRAP) 50 (29-73) vs 69 (51-92), p=0.04 and collagen 24 (17-28) vs 34 (26-59), p<0.01. The IB blood had higher amounts of free hemoglobin (mg/L) (1086 (891-1717) vs 591(517-646), p<0.01) and D-dimer 0.60 (0.33-0.98) vs 0.3 (0.3-0.48), p<0.01. Other coagulation variables showed no difference between the groups. The handling of blood after CPB increases hemolysis, impairs platelet function and activates coagulation and fibrinolysis. The RC technique preserved the blood better than the commonly used IB technique.

Effect of Hydroxyethyl Starch Priming on the Systemic Inflammatory Response and Lung Edema after Cardiopulmonary Bypass in a Rat Model.

Cardiopulmonary bypass (CPB) preserves patients' lives during open heart surgery by providing sufficient oxygen delivery and blood supply to vital organs. However, previous studies have suggested that the interaction of hemodilution and vascular hyperpermeability induces tissue edema and an inflammatory response during CPB. In this study, we hypothesized the suppression of the systemic inflammatory response and tissue edema during CPB by a plasma substitute (hydroxyethyl starch [HES]). Rats (450-500 g) were divided into a SHAM group (n = 5), a Ringer's acetate CPB group (n = 7), and an HES CPB group (n = 7). In the Ringer's acetate group, the CPB circuit was primed with Ringer's acetate solution, and in the HES CPB group, it was primed with HES formulation (6% HES 130/0.4). Blood samples were collected before (baseline) and 30, 60, 90 and 120 min after initiation of CPB. Plasma cytokine levels of tumor necrosis factor-α, interleukin (IL)-6, and IL-10, and biochemical markers (lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, creatinine, liver-type fatty acid-binding protein, and colloid osmotic pressure [COP]) were measured before and 30, 60, 90, and 120 min after the initiation of CPB. In the Ringer's acetate CPB group, the inflammatory cytokines and biochemical markers increased significantly during CPB compared with the SHAM group, but such increases were significantly suppressed in the HES CPB group. In addition, during CPB, it was possible to preserve normal plasma COP in the HES CPB group. The data suggest that 6% HES 130/0.4 is effective for suppressing the inflammatory response during CPB.

Effects of hydroxyethyl starch 130/0.42 vs. Ringer's acetate on cytokine levels in severe sepsis.

The Scandinavian Starch for Severe Sepsis/Septic Shock (6S) trial showed increased 90-day mortality with hydroxyethyl starch (HES) 130/0.42 vs. Ringer's acetate. To explore the underlying pathophysiology, we compared early changes in plasma cytokine concentrations between patients resuscitated with HES vs. Ringer's acetate. In a subgroup of 226 patients from the 6S trial, we calculated delta plasma concentrations of tumour necrosis factor alpha (TNF-α), interleukin (IL)-6 and IL-10 from randomization to day 2. We used multiple linear and logistic regression analyses to assess differences between the groups and associations between delta cytokine concentrations and 90-day mortality, respectively. Baseline characteristics and day 2 mortality were comparable between the groups. We observed similar delta cytokine concentrations in the HES vs. Ringer's group (mean difference in delta TNF-α: -1.5 pg/ml (95% CI, -4.9 to 1.9), P = 0.39; IL-6: 36.0 pg/ml (-24.1 to 96.1), P = 0.24; IL-10: -3.9 pg/ml (-21.1 to 28.9), P = 0.76). In all included patients, we observed a linear relationship between increases in TNF-α and 90-day mortality (P = 0.005). Resuscitation with HES 130/0.42 vs. Ringer's acetate did not appear to affect plasma concentrations of TNF-α, IL-6 or IL-10 differently during the first days after randomization into the 6S trial. In the overall cohort, increases in TNF-α were associated with increased 90-day mortality. Although interpretation should be done with caution, it seems unlikely that the increased mortality observed with the use HES in the 6S trial is signalled by early changes in three biomarkers of systemic inflammation.

Management of infusion reactions associated with cetuximab treatment: A case report.

Cetuximab is a drug targeting the epidermal growth factor receptor, which is indicated for the treatment of unresectable advanced or recurrent head and neck or colorectal cancer. Cetuximab also enhances the cytotoxic effects of radiation in squamous cell carcinoma. The severity of infusion reactions (IR) is categorized from grade 1 to 5; grades 3 and 4 are associated with life-threatening reactions (anaphylaxis), whereas grade 5 indicates death. The incidence of grade 3–4 IR with premedication is reported to be 1.1%. We herein describe a case of a 77-year-old man who developed IR during intravenous administration of cetuximab. The patient developed grade 3–4 anaphylaxis with pruritus, rash and urticaria, followed by hypotension and bradycardia. The timely diagnosis and treatment with intravenous infusion of a vasopressor drug and Ringer's acetate solution proved to be effective. The case presented herein demonstrated an unfeatured aspect of cetuximab-related IR as dermatological reactions over the entire body followed by circulatory collapse.

Is perioperative administration of 5% dextrose effective in reducing the incidence of PONV in laparoscopic cholecystectomy?: A randomized control trial

Study objectiveTo compare the incidence of postoperative nausea and vomiting (PONV) during perioperative administration of 5% dextrose and normal saline in laparoscopic cholecystectomy. DesignProspective, randomized, double-blind trial. SettingOperating rooms in a tertiary care hospital of Northern India. PatientsOne hundred patients with American Society of Anesthesiologists status I to II undergoing laparoscopic cholecystectomy were enrolled in this study. InterventionsPatients were randomized into two groups [normal saline (NS) group and 5% dextrose (D) group]. Both the groups received Ringer acetate (Sterofundin ISO) intravenously as a maintenance fluid during intraoperative period. Besides this, patients of group NS received 250ml of 0.9% normal saline and patients of group D received 5% dextrose @ 100ml/h started at the time when gall bladder was taken out. It was continued in the postoperative period with the same rate till it gets finished. MeasurementsIncidence of PONV, Apfel score, intraoperative opioids used and consumption of rescue antiemetics. Main resultsDemographic data was statistically similar. Out of total 100 patients, 47 patients (47%) had PONV. In group D, 14 patients (28%) had PONV while in group NS, 33 patients (66%) had PONV within 24h of surgery (p value 0.001). The incidence of PONV was reduced by 38% in group D which is significantly lower when compared with that of group NS (p value 0.001). The consumption of single dose of rescue antiemetics in group D was also reduced by 26% when compared to that of group NS (p value 0.002). ConclusionsPerioperative administration of 5% dextrose in patients undergoing laparoscopic surgery can reduce PONV significantly and even if PONV occurs, the quantity of rescue antiemetics to combat PONV is also reduced significantly.

Effect of acetate Ringer&lt;sup&gt;’&lt;/sup&gt;s solution with or without 5% dextrose administered intravenously to diarrheic calves

The objectives of this study were to evaluate the effects of intravenous acetate Ringer’s solution, with or without dextrose, on diarrheic calves with either experimentally induced or spontaneous diarrhea. In the experimental model, diarrhea was induced in nine healthy calves by administering cold milk (below 4°C) twice a day for 2 days. The calves were randomly assigned to the isotonic saline (ISS), acetated Ringer’s (AR) or acetated Ringer’s with 5% dextrose (ARD) groups, with three calves assigned to each group. The calves received 80 ml/kg of their designated solution, at a flow rate of 20 ml/kg/hr. Infusion of ISS, AR and ARD were all found to be safe and effective in increasing plasma volume. Intravenous (IV) infusion of ISS resulted in the acidification secondary to dilution, while AR and ARD infusion inhibited acidification. In addition, prevention of catabolism was observed only with IV infusion of ARD. Sixteen calves with spontaneous diarrhea were enrolled in the clinical study. The calves were randomly assigned to the AR or ARD groups, with eight calves being assigned to each group. The calves received 100 ml/kg of their designated solution, at a flow rate of 25 ml/kg/hr. Intravenous infusion of AR and ARD was found to be effective in increasing plasma volume and inhibiting acidification. Only infusion of ARD prevented catabolism, but it also led to hyperglycemia. Our results suggest that a solution containing dextrose may be beneficial for wasting diarrheic calves.

Influences of red blood cell and platelet counts on the distribution and elimination of crystalloid fluid

Background and objectiveA high number of blood cells increases the viscosity of the blood. The present study explored whether variations in blood cell counts are relevant to the distribution and elimination of infused crystalloid fluid. Materials and methodsOn three different occasions, 10 healthy male volunteers received an intravenous infusion of 25mL/kg of Ringer's acetate, Ringer's lactate, and isotonic saline over 30min. Blood hemoglobin and urinary excretion were monitored for 4h and used as input in a two-volume kinetic model, using nonlinear mixed effects software. The covariates used in the kinetic model were red blood cell and platelet counts, the total leukocyte count, the use of isotonic saline, and the arterial pressure. ResultsRed blood cell and platelet counts in the upper end of the normal range were associated with a decreased rate of distribution and redistribution of crystalloid fluid. Simulations showed that high counts were correlated with volume expansion of the peripheral (interstitial) fluid space, while the plasma volume was less affected. In contrast, the total leukocyte count had no influence on the distribution, redistribution, or elimination. The use of isotonic saline caused a transient reduction in the systolic arterial pressure (P<0.05) and doubled the half-life of infused fluid in the body when compared to the two Ringer solutions. Isotonic saline did not decrease the serum potassium concentration, despite the fact that saline is potassium-free. ConclusionsHigh red blood cell and platelet counts are associated with peripheral accumulation of infused crystalloid fluid.

Modified acetate Ringer's solutions versus Ringer's lactate solutions in perioperative patients: a systematic review

Objective To systematically review published randomized controlled trials(RCTs) comparing perioperative administration of modified Ringer's acetate(PA) versus Ringer's lactate solutions (LR) in terms of effect on patient outcomes, so as to provide some evidence for volume expansion. Methods PubMed, EMBASE, Cochrane library, Web of Science, Chinese Science Citation Database(CSCD), Chinese Biomedical Literature Database (CBM) were searched to identify RCTs comparing PA and LR published between January 1996 and June 2015. Cochrane Risk of Bias Tool was applied to assess the quality of literature. The RCTs meeting the criterion of inclusion were selected for meta-analysis. Outcomes included mortality, organ failure, pH, base excess (BE), partial pressure of carbon dioxide(PaCO2), lactate concentration, and bicarbonate anion(HCO3-). Results 265 published papers were searched, from which 12 RCTs (with 664 patients) were eligible according to the inclusion criterion. Mata-analysis showed that there were no statistically significant differences between PA group and LR group in BE and HCO3; pH value in the PA group was higher than that in the LR group(P=0.04); PaCO2 was higher in the LR(P=0.013); blood lactate concentration was higher in the LR group(P=0.000). Conclusion This study showed that modified Ringer acetate solution may reduce blood lactate concentration compared with Ringer lactate solution. However, the studies included in this review were of poor quality. The evaluation and comparison of these solutions for volume expansion is subject to investigation with high-quality randomised controlled double-blind large trials. Key words: Intraoperative period; Ringer's lactate solution; Modified acetate Ringer's solutions

Prone Versus Sitting Position in Neurosurgery—Differences in Patients' Hemodynamic Management

Neurosurgery in general anesthesia exposes patients to hemodynamic alterations in both the prone and the sitting position. We aimed to evaluate the hemodynamic profile during stroke volume-directed fluid administration in patients undergoing neurosurgery either in the sitting or the prone position. In 2 separate prospective trials, 30 patients in prone and 28 patients in sitting position were randomly assigned to receive either Ringer acetate (RAC) or hydroxyethyl starch (HES; 130 kDa/0.4) for optimization of stroke volume. After combining data from these 2 trials, 2-way analysis of variance was performed to compare patients' hemodynamic profile between the 2 positions and to evaluate differences between RAC and HES consumption. To achieve comparable hemodynamics during surgery, a higher mean cumulative dose of RAC than HES was needed (679 mL ± 390 vs. 455 mL ± 253; P < 0.05). When fluid consumption was adjusted with weight, statistical difference was lost. Fluid administration did not differ between the prone and sitting position. Mean arterial pressure was lower and cardiac index and stroke volume index were higher over time in patients in the sitting position. The sitting position does not require excess fluid treatment compared with the prone position. HES is slightly more effective than RAC in achieving comparable hemodynamics, but the difference might be explained by patient weight. With goal-directed fluid administration and moderate use of vasoactive drugs, it is possible to achieve stable hemodynamics in both positions.

Intra-operative administration of low-dose IV glucose attenuates post-operative insulin resistance.

Insulin sensitivity often decreases after surgery in spite of normal insulin secretion, and may worsen the outcome. This post-operative insulin resistance increases according to the magnitude of surgical invasion. However, supplementation of carbohydrates before surgery attenuates the post-operative insulin resistance. This study aimed to investigate the effect of intra-operative administration of low-dose glucose on the post-operative insulin resistance. Patients undergoing maxillofacial surgery were randomly assigned to two groups throughout the surgical procedure: The glucose group receiving acetated Ringer solution with 1.5% glucose and the control group receiving acetated Ringer solution without glucose. Insulin resistance quantified by the mean glucose infusion rate (the glucose infusion rate) was evaluated by glucose clamp using the STG-22TM instrument on the previous day and on the next day of surgery. Blood glucose level was monitored continuously during surgery. In addition, serum insulin, ketone bodies and 3-methylhistidine were measured during perioperative period. Patients in the glucose group (n=11) received 0.15 ± 0.06 g/kg/h of glucose during surgery, while patients in the control group (n=11) received no glucose. In both groups, however, the mean blood glucose levels were maintained stable at less than 150 mg/dL during and after surgery. The serum ketone bodies significantly increased after surgery in the control group (p=0.0035), while it decreased significantly in the glucose group (p=0.043). The reduction rate in the glucose infusion rate was significantly lower in the glucose group, 43.3 ± 20.7%, than that in the control group, 57.7 ± 9.3% (p=0.041). Intra-operative small-dose of glucose administration may suppress ketogenesis and attenuate the post-operative insulin resistance without causing hyperglycemia.