Ringer's Lactate Group Research Articles

Role of Preservation Solution in Human Aneurysmatic Aorta Harvest and Transport: A Comparative Analysis of Different Solutions for Tissue Injury Protection.

Human aortic tissues in vitro are tools to clarify the pathophysiological mechanisms of the cardiovascular system, cell culture, and transplants. Therefore, this study aims to analyze and compare the preservation of human aneurysmatic aortic tissues in three different solutions. Six human abdominal aortic aneurysms were obtained from patients after surgical ablation. The aorta samples were incubated in different solutions - 0.9% normal physiological saline solution, Ringer's lactate solution, and histidine-tryptophan-ketoglutarate solution (Custodiol®). Segments were collected at 0, 6, 24, and 48 hours. Creatine kinase and nitrate/nitrite were quantified for each incubation time. The tissue's alpha-smooth muscle actin was analyzed by immunofluorescence. There was a significant increase in creatine kinase formation in the normal saline group at 0 and 48 hours and in the Ringer's lactate group at 0 and 48 hours (P=0.018 and P=0.028). The lower levels of creatine kinase and nitrate/nitrite and the aortic tissues' morphological integrity show that histidine-tryptophan-ketoglutarate has better tissue protection. These data suggest that histidine-tryptophan-ketoglutarate induces a protective effect on smooth muscle cells, with less tissue depletion in the aortic aneurysm. This study compared three preservation solutions with the potential for human abdominal aortic aneurysm tissue preservation. The histidine-tryptophan-ketoglutarate solution reduced tissue injury and improved tissue preservation in human abdominal aortic aneurysm tissue samples.

Assessment of IV albumin and ringer lactate on the acute oral toxicity of acetylsalicylic acid in albino rats

BackgroundDespite the frequent inclusion of fluid therapy in the treatment of many conditions, there are limited studies available to provide an evidence-based specific recommendation for fluid therapy in acute drug toxicity. Salicylate toxicity is considered one of the common clinical problems. It is commonly associated with fatal complications and even can lead to death. The study was designed to investigate the effects of various IV fluid types as isotonic saline (NaCl 0.9%), Ringer lactate (RL), and albumin and their impact on acetyl salicylic acid (ASA) toxicity outcome in a rat model of acute salicylate toxicity.Sixty male Albino rats were divided into 10 groups of 6 rats each. The first four groups were the control, saline, RL, and albumin groups. The fifth group received two doses of ASA solution orally, and the next five groups were treated with IV fluids as follows: saline-ASA, RL-ASA, albumin-ASA, RL + albumin-ASA, and saline + albumin-ASA. Upon completion of the study, spirometry, arterial blood gas analysis (ABG), and serum liver and kidney function tests were done on all groups. Furthermore, quantitative real-time polymerase chain reaction (PCR) was used to assess interleukin-6 (IL6), nuclear factor kappa beta (NF-kβ), and beta-actin mRNA gene expression of histopathology and immunohistochemistry assessments were also performed on liver and kidney tissues.ResultsThe results revealed the ASA group showed marked deterioration across all the investigated parameters. The groups that received saline and RL showed improvements in the following: respiratory rates, ABG, liver and kidney function, and histopathological findings.The RL + albumin group did not show any improvements. The albumin group and the saline + albumin group showed variable responses, ranging from mild improvement to no improvement.ConclusionsThe saline and RL groups showed positive results; however, the RL + albumin group showed the worst outcomes. The inclusion of albumin did not appear to provide any extra benefits and produced varying results.

Compound electrolyte intraocular irrigating solution produces better effects on vision recovery of cataract patients after surgery than Ringer lactate solution.

Intraocular irrigating solution is extensively applied in cataract surgery. This paper explored the difference and relationship between optical coherence tomography (OCT) and optical quality analysis system (OQAS) parameters induced by compound electrolyte intraocular irrigating solution (CEIIS) or Ringer lactate (RL) solution during uncomplicated cataract surgery. Totally 200 senior cataract patients were randomly divided into the CEIIS and RL groups (N = 100 patients/group). The anterior chamber was irrigated by CEIIS or RL during phacoemulsification. Patients were subdivided into diabetes mellitus (DM)+ and DM- groups. The central macular thickness (CMT), hyper reflective foci (HF), modulation transfer function cutoff frequency (MTF cutoff), Strehl ratio (SR), objective scatter index (OSI), and OQAS values (OVs) at 100%, 20%, and 9% contrast levels were measured preoperatively and 1day and 1week after operation using spectral-domain optical coherence tomography and OQAS II, respectively. Best-corrected visual acuity (BCVA) was assessed using the Snellen scale, followed by statistical analysis of its logarithm of the minimal angle of resolution. There were no significant differences in clinical characteristics between the CEIIS and RL groups. Both groups exhibited notably increased postoperative CMT, MTF cutoff, SR, OV at 100%, 20%, and 9% contrast levels, and reduced OSI, indicating CEIIS and RL improved postoperative visual quality. CEIIS surpassed RL solution in improving postoperative visual quality, decelerating the increase of macular HF numbers and CMT in DM+ patients and postoperative BCVA. There was no difference between CEIIS and RL in long-term vision improvement. CEIIS surpasses RL in postoperative visual recovery and retards increases of macular HF numbers and CMT in senior DM+ cataract patients.

Comparison of efficacy of intraoperative intravenous 5% dextrose versus intravenous ringer lactate for prevention of postoperative nausea and vomiting in patients undergoing elective laparoscopic cholecystectomy.

Objective: To assess the effectiveness of intraoperative intravenous 5% dextrose in contrast to intravenous Ringer lactate for averting postoperative nausea and vomiting among individuals undergoing elective laparoscopic cholecystectomy at a Tertiary Care Hospital in Karachi. Study Design: Randomized Control Trial. Setting: Department of Anesthesia, Dow University of Health Sciences, Located at Civil Hospital in Karachi. Period: 25-09-20 to 25-03-21. Methods: Patient data was collected in a prospective manner following verbal consent. A total of 60 patients, meeting the diagnostic criteria, were incorporated in the study. A concise medical history was obtained, and demographic details were recorded in the performa. Data was all variables were collected and analysed using SPSS version 22. Results: This study encompassed a total of 60 patients. In the dextrose group, the mean age, duration of surgery, length of hospital stay, height, weight, and BMI were 48.21±6.24 years, 2.54±1.78 hours, 4±2.54 days, 147±4.21 cm, 71.7±7.25 kg, and 28.9±5.14 kg/m2, respectively. Conversely, in the ringer lactate group, these values were 49.48±8.41 years, 2.97±1.56 hours, 4±1.89 days, 158±5.28 cm, 78.7±9.87 kg, and 29.6±4.91 kg/m2. The efficacy for preventing postoperative nausea and vomiting was 80% for the dextrose group and 36.7% for the ringer lactate group in our study. Conclusion: Administering preoperative fluid supplementation with dextrose resulted in a reduced occurrence of postoperative nausea and vomiting (PONV) in comparison to ringer lactate.

Goal-Directed Fluid Therapy Using Normal Saline versus Ringer's Lactate in Pediatric Neurosurgical Patients: A Randomized Controlled Trial

Abstract Background Ringer's lactate (RL) and 0.9% sodium chloride (NS) are used intraoperatively in pediatric surgical patients. The fluid of choice in pediatric neurosurgical patients is still under research. Hence, we compared NS and RL intraoperatively with a primary objective of measuring the absolute difference in serum chloride concentrations (ΔCl-) after surgery from baseline. Secondary objectives included changes in other electrolytes, osmolarity, pH, creatinine, brain relaxation score (BRS), and neurological outcome at discharge using a modified Rankin scale (mRS). Methods This prospective randomized trial was conducted in American Society of Anesthesiologists status I to II children, aged 6 months to 14 years, after Institutional Ethical Committee approval and written informed consent. Forty patients were randomized in group-S (received 0.9% Saline) and group-R (received RL). The fluid administration was guided by Pleth Variability Index (target <13%). Arterial blood samples were taken at the start of surgery, during tumor resection, and at the end of surgery. Results Twenty-one patients in NS and 19 patients in RL were enrolled. ΔCl- was 12 (9–16) mmol/L in NS group and 4 (2–15) mmol/L in RL group, p = 0.03. NS group developed more metabolic acidosis (6 [28.6%] vs. 0 [0.0%], p = 0.021). There was no difference in the other electrolytes, serum osmolarity, BRS, perioperative creatinine, and mRS between groups, p = 0.36, p = 0.096, p = 0.658, and p = 0.168, respectively. Conclusion Intraoperative use of NS causes derangement in chloride balance, leading to metabolic acidosis compared to RL in children undergoing neurosurgical procedures. However, there was no difference in the other parameters, including serum osmolarity, BRS, and mRS.

Comparison of six percent hydroxyethyl starch 130/0.4 and ringer's lactate as priming solutions in patients undergoing isolated open heart valve surgery: A double-blind randomized controlled trial.

Colloids are added to the priming solution of the cardiopulmonary bypass (CPB) pump to maintain colloid osmotic pressure and prevent fluid overload. This study aimed to compare the effects of 6% hydroxyethyl starch (HES) 130/0.4 and ringer's lactate (RL) priming solution on patients' outcomes undergoing isolated heart valve surgery with CPB. This randomized clinical trial included one hundred and 20 patients undergoing heart valve surgery, and those were allocated into two groups. Patients in the RL group received 1500mL of RL, and those in the RL + HES group were given 500mL of HES and 1000mL of RL. The patients' median age was 52 (IQR 42-60) and 50 (IQR 40-61) years in the RL + HES and the RL group, respectively (p = .71). The number of cases that required blood product transfusion in both the operating room and intensive care unit was also significantly higher in the RL + HES group compared to the RL group (RR 2.04, 95% CI 1.50-2.76; p < .01 and RR 1.42, 95% CI 1.01-2.01; p = .05, respectively). Declines in postoperative creatinine levels and platelet counts were higher in the RL + HES compared to the RL group (between-subjects effect p = .007 and p = .038, respectively), while the incidence of acute kidney injury was comparable between groups (RR 0.66, 95% CI 0.13-3.30; p = .55). Among patients undergoing heart valve surgery with CPB, 6% HES added to RL for priming compared with only RL increased the risk of the need for blood product transfusion over the hospitalization period.

Effects of Different Crystalloid Fluids on Renal Tissue in an Experimental Model of Hemorrhagic Shock.

The type of fluid that should be used in uncontrollable hemorrhages remains an area of research. This study was designed to compare the effects of resuscitation with Ringer's lactate (RL) solution versus a normal saline (NS) solution on hemodynamics, renal tissue histopathology, coagulation, and apoptosis in a rat model of hemorrhagic shock. The study employed groups designated as the control, hemorrhage, NS, and RL groups. Heart rate, mean arterial pressure, and respiratory rate were monitored. Annexin A5 values were assayed, rotational thromboelastometry analysis was performed, and excised kidney tissue samples were histopathologically analyzed. Blood pressure levels were found to be significantly higher in the control group than those measured in the other groups. While the clotting time (CT) and clot formation time (CFT) in the hemorrhage group were significantly longer than those in the control and RL groups, the CT and CFT measured in the control group were significantly shorter compared to the RL group. The mean Annexin A5 level was in the hemorrhage group, which was significantly higher compared to the other groups. In the renal histopathological evaluation, the scores of proximal tubular injury, distal renal tubular injury, and interstitial renal tubular injury were found to be significantly lower in the control group compared to the other groups. This study demonstrated that NS or RL can be used safely to improve the hemodynamic symptoms resulting from hemorrhagic shock as a means to reduce apoptosis, and to decrease findings in favor of coagulopathy in bedside coagulation tests during the early stages of hemorrhagic shock until the time of starting a blood transfusion.

Psychodermatology: The Significant Interaction Between the Mind and Skin

Background: Fluid therapy in perioperative cesarean section remains a debated topic. Its purpose is to maintain or restore circulating blood volume and may affect the plasma acid-base balance of mother and neonatal. Therefore, the aim of this study was to compare the effects of Normal saline with Ringer's lactate serum on the acid-base status of mother and neonate in elective cesarean section. Methods: forty-eight healthy term parturient women scheduled for elective cesarean section were randomly divided into two groups (24 patients each). The first group received Normal saline serum and the second group received ringer lactate serum. Maternal blood samples were obtained from an indwelling cannula in a peripheral hand vein and Fetal arterial and venous blood samples were obtained at birth from a double-clamped umbilical cord. The data collected during the study included PH, PCO2, HCO3 and BE. At birth, 1- and 5-minute Apgar scores were recorded. Data were analyzed using descriptive statistics and inferential statistics at a significance level of less than 0.05. Results: Patients did not differ significantly in terms of demographic characteristics. The acidosis in mothers was higher in lactated ringer group (5%, p &lt;0.001). There was no difference in Apgar score between the two groups. Conclusion: Normal saline compared to lactated ringer causes acidosis in mothers under elective cesarean section with spinal anesthesia, but none of them has a significant effect on the acid-base status of the infant. Appropriate fluid therapy aimed at optimization of pH can be effective for mothers who are at higher risk for acidosis.

Comparison of albumin 4%, gelatine, and ringer lactate as volume expander post-resuscitative phase on cardiac output and lactate serum after Coronary Arterial Bypass Grafting (CABG) on-pump: Single-center randomized prospective study

Background. The use of protein colloid in fluid management post-cardiac surgery is debatable whether it is more beneficial than non-protein colloid or crystalloid. Patients who still need more volume after the resuscitative phase might benefit from optimal fluid management by choosing the most beneficial fluid. This study compared albumin 4% administration to gelatine and ringer lactate as a volume expanders post-resuscitative phase after coronary artery bypass grafting (CABG) on-pump.Methods. We conducted a single-centered, single-blind, randomized controlled study that assigned 120 patients undergoing elective CABG on-pump. Subjects who met inclusion criteria received 125 ml/hour of either albumin 4%, gelatine colloid, or Ringer's lactate (RL) as the only infusion fluid for 4 hours after the first assessment post-resuscitative phase, after intensive care unit (ICU) admission. After fluid administration, patients were reassessed. The assessment included cardiac output and lactate serum as the primary outcome, while the duration of mechanical ventilation, ICU, and hospital stay were recorded as secondary outcomes.Results. The mean of cumulative cardiac output improvement differed between the group albumin 4% 1.18 L/min, gelatine 0.88, and RL 0.74 (p=0.002). Lactate serum decreased in the albumin 4% group as much as 3.31 gr/dl compared to gelatine 2.13 and RL group 2.37 (p=0.005). Duration of mechanical ventilation, length of stay in ICU, and hospital post-operative were shorter in the albumin group than in other groups. Conclusions. Albumin 4% used as a volume expander in the post-resuscitative phase still improved cardiac output and tissue micro-perfusion than gelatine and ringer lactate.

Hemoglobin-albumin clusters as an artificial O2 carrier: Physicochemical properties and resuscitation from hemorrhagic shock in rats.

A bovine hemoglobin (HbBv) or human adult hemoglobin (HbA) wrapped covalently by human serum albumins (HSAs), hemoglobin-albumin clusters (HbBv-HSA3 and HbA-HSA3 ), are artificial O2 carriers used as a red blood cell substitute. This article describes the physicochemical properties of the HbBv-HSA3 and HbA-HSA3 solutions, and their abilities to restore the systemic condition after resuscitation from hemorrhagic shock in anesthetized rats. The HbBv-HSA3 and HbA-HSA3 , which have high colloid osmotic activity, showed equivalent solution characteristics and O2 binding parameters. Shock was induced by 50% blood withdrawal. Rats exhibited hypotension and significant metabolic acidosis. After 15 min, the rats were administered shed autologous blood (SAB), HbBv-HSA3 , HbA-HSA3 , or Ringer's lactate (RL) solution. Survival rates, circulation parameters, hematological parameters, and blood gas parameters were monitored during the hemorrhagic shock and for 6h after administration. All rats in the SAB, HbBv-HSA3 , and HbA-HSA3 groups survived for 6h. The HbBv-HSA3 and HbA-HSA3 groups restored mean arterial pressure after the resuscitation. No remarkable difference was observed in the time courses of blood gas parameters in any resuscitated group except for the RL group. Serum biochemical tests showed increases in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in the HbBv-HSA3 and HbA-HSA3 groups compared to the SAB group. Therefore, we observed other rats awakened after resuscitation with HbA-HSA3 for 7 days. The blood cell count, AST, and ALT recovered to the baseline values by 7 days. All the results implied that HbBv-HSA3 and HbA-HSA3 clusters provide restoration from hemorrhagic shock as an alternative material for SAB transfusion.

COMPARATIVE STUDY OF RINGER’S LACTATE AND 6% HYDROXYETHYL STARCH AS PRELOADING FLUID FOR PREVENTION OF HYPOTENSION FOLLOWING SUBARACHNOID BLOCK

Background and Objective: To compare the efcacy of Ringer's lactate and 6% hydroxyethyl starch in reducing the incidence and severity of hypotension after subarachnoid block. Design: Prospective and randomized comparative study. Materials and methods: 100 patients in the age group of 20 to 60 years of ASA Grade I scheduled for elective lower abdominal and lower limb surgeries were randomly allocated into two groups. CRL-Group: received 20ml/kg of Ringer's lactate. COL-Group: received 10 ml/kg of HES 6%20 minutes prior to spinal anaesthesia. Pulse rate, systolic, diastolic and mean arterial blood pressure was recorded at an interval of every minute up to 5 minutes, every 5 minutes up to 60 minutes duration. Results: The incidence of hypotension was 86% in CRL-Group, and 6% in COL-Group, which was statistically signicant. The Mephentermine bolus requirements were less in COL-Group (3 of 50 patients) when compared to CRL-Group (43 of 50 patients). None of them have allergic reactions in COL-Group. Interpretation and Conclusion: It was observed from our study that 6% HES group reduces incidence of hypotension after subarachnoid block, thus requiring lesser mean dose requirements of Mephentermine when compared to Ringer's lactate group. 6% HES is effective and safer when compared with Ringer's lactate in preventing hypotension in patients undergoing surgeries under SAB. In conclusion we found that colloids when compared with crystalloids reduce the incidence of spinal anaesthesia induced hypotension.

H12‐(ADP)‐liposomes for hemorrhagic shock in thrombocytopenia: Mesenteric artery injury model in rabbits

BackgroundDamage control resuscitation improves patient outcomes after severe hemorrhage and coagulopathy. However, effective hemostasis methods for these critical situations are lacking. ObjectiveWe evaluated the hemostatic efficacy of fibrinogen γ‐chain (HHLGGAKQAGDV, H12)‐coated, adenosine‐diphosphate (ADP)‐encapsulated liposomes (H12‐[ADP]‐liposomes) in thrombocytopenic rabbits with hemorrhagic shock. MethodsAcute thrombocytopenia (80%) was induced in rabbits that also received mesenteric vessel injury, leading to hemorrhagic shock. Five minutes after injury, subjects received intravenous bolus injection with H12‐(ADP)‐liposomes (20 mg/kg), followed by isovolemic transfusion with stored red blood cells (RBCs)/platelet poor plasma (PPP) (RBC:PPP = 1:1 [vol/vol]), or lactated Ringer solution every 5 min to compensate blood loss. One group received H12‐(phosphate buffered saline [PBS]) liposomes followed by RBC/PPP. Additional groups were received isovolemic transfusion with RBC/platelet rich plasma (PRP) (RBC:PRP = 1:1 [vol/vol]), RBC/PPP, PPP alone, or lactated Ringer solution. ResultsTreatment with H12‐(ADP)‐liposomes followed by RBC/PPP transfusion and RBC/PRP transfusion effectively stopped bleeding in all thrombocytopenic rabbits. In contrast, three of 10 rabbits treated with RBC/PPP failed hemostasis, and no rabbits receiving lactated Ringer solution stopped bleeding or survived. Twenty‐four hours after hemorrhage, 80% of rabbits receiving H12‐(ADP)‐liposome followed by RBC/PPP transfusion survived and 70% of rabbits receiving RBC/PRP transfusion also survived, although RBC/PPP‐transfused rabbits showed 40% survival. Rabbits receiving H12‐(ADP)‐liposomes followed by lactated Ringer solution showed a transient hemostatic potential but failed to survive. H12‐(PBS)‐liposomes showed no beneficial effect on hemostasis. Neither the PPP group nor the lactated Ringer group survived. ConclusionH12‐(ADP)‐liposome treatment followed by RBC/PPP may be effective in lethal hemorrhage after mesenteric vessel injury in coagulopathic rabbits.

Lactated Ringer Solution Is Superior to Normal Saline Solution in Managing Acute Pancreatitis: An Updated Meta-analysis of Randomized Controlled Trials.

The goal of this study was to further determine the role of lactated Ringer (LR) compared with normal saline (NS) in managing acute pancreatitis (AP) as a consideration of fluid resuscitation. Fluid resuscitation play a critically important role in managing AP, and NS and LR solutions were common selection in clinical practice. However, it remains debate about which regime may be more better for patients with AP. The PubMed, Embase, and the Cochrane library were searched to find eligible randomized controlled trials focusing on the comparative efficacy and safety of LR and NS for the management of patients with AP. Four eligible randomized controlled trials involving 248 patients to perform meta-analysis finally. Meta-analysis suggested no statistical difference between LR and NS groups in reducing the incidence of systemic inflammatory response syndrome at 24 hours [risk ratio (RR)=0.66, 95% confidence interval (CI)=0.33-1.31, P=0.24], 48 hours (RR=0.70, 95% CI=0.29-1.68, P=0.42), and 72 hours (RR=0.68, 95% CI=0.37-1.25, P=0.22). Meanwhile, no statistical difference was detected between LR and NS groups in terms of in-hospital mortality, incidence of local complications, pancreatic necrosis, organ failure, and developing moderate-to-severe AP, and the length of hospital stay. However, incidence of intensive care unit admission in LR group was significantly lower than that in NS group (RR=0.39, 95% CI=0.18-0.85; P=0.02). The current updated meta-analysis indicates that LR may be superior to NS in managing patients with AP because of LR has a potential advantage in decreasing the incidence of pancreatic necrosis and intensive care unit admission compared with NS.

Impact of colloids or crystalloids in renal function assessed by NGAL and KIM-1 after hysterectomy: randomized controlled trial

BackgroundHydroxyethyl starches are colloids used in fluid therapy that may reduce volume infusion compared with crystalloids, but they can affect renal function in critical care patients. This study aims to assess renal effects of starches using renal biomarkers in the perioperative setting. MethodsThis prospective, controlled, randomized study compared Hydroxyethyl starch 6% (HES) with Ringer's lactate (RL) in hysterectomy. Each episode of mean arterial pressure (MAP) below 60 mmHg guided the fluid replacement protocol. The RL group received 300 mL bolus of RL solution while the HES group received 150 mL of HES solution. All patients received RL (2 mL.kg−1.h−1) intraoperatively to replace insensible losses. Blood and urine samples were collected at three time points (preoperatively, 24 hours, and 40 days postoperatively) to assess urinary NGAL and KIM-1, as primary outcome, and other markers of renal function. ResultsSeventy patients were randomized and 60 completed the study. The RL group received a higher crystalloid volume (1,277 ± 812.7 mL vs. 630.4 ± 310.2 mL; p = 0.0002) with a higher fluid balance (780 ± 720 mL vs. 430 ± 440 mL; p = 0.03) and fluid overload (11.7% ± 10.4% vs. 7.0% ± 6.3%; p = 0.04) compared to the HES group. NGAL and KIM-1 did not differ between groups at each time point, however both biomarkers increased 24 hours postoperatively and returned to preoperative levels after 40 days in both groups. ConclusionHES did not increase renal biomarkers following open hysterectomy compared to RL. Moreover, HES provided better hemodynamic parameters using less volume, and reduced postoperative fluid balance and fluid overload.

Comparison between Glucose Containing Solution D2.5% and Ringer Lactate as a Maintenance Fluid Management in Infants Undergoing Inguinal Hernia Repair

Abstract Background Infants and neonates are at particular risk of hypoglycemia when suffering from sepsis, asphyxia and hypothermia. A prospective study showed that up to 20% of preterm infants who were ready for discharge were still at risk of hypoglycemia when a feed was delayed. In contrast, surgery and critical illness may cause hyperglycemia. Objectives The aim of this study is to Assessment of glucose containing solutions 2.5 % as a maintenance fluid management intra operative in infants undergoing hernia repair as regard hyperglycemia and hypoglycemia. Patients and Methods The study was conducted on 100 randomly chosen patients aged from 28 days to 1 year, American Society of Anesthesiologists (ASA) class I scheduled for elective open inguinal hernia repair in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 50 patients each: Ringer lactate Group: patients received ringer lactate as maintenance fluid therapy according to body weight, glucose containing solution: patients received glucose containing solution 2.5% as maintenance fluid therapy according to body weight. Results The results of the study revealed that 12% of patients receiving glucose containing solution 2.5 % had simple hyperglycemia with no hypoglycemic patients recorded while the other group with ringer lactate 2% of patients had simple hyperglycemia and 4% of patients had hypoglycemia . Conclusion The usage of glucose containing solution 2.5% remained controversial, in this study we compared glucose 2.5 % in normal saline 0,9 % to ringer lactate and the results didn’t put a final decision to the usage of glucose containing solutions as The results of the study revealed that 12% of patients receiving glucose containing solution 2.5 % had simple hyperglycemia with no hypoglycemic patients recorded while the other group with ringer lactate 2% of patients had simple hyperglycemia and 4% of patients had hypoglycemia.

Normal Saline Versus Balanced Crystalloids in Renal Transplant Surgery: A Double-Blind Randomized Controlled Study.

BackgroundThe importance of optimal acid-base balance during renal transplant surgeries cannot be stressed enough. Optimal preload and electrolyte balance is important in maintaining this. There has been a debate on the choice of perioperative crystalloids in renal transplant surgeries over the past decades. Normal saline (0.9% saline) is more likely to cause hyperchloremic acidosis when compared to balanced salt solutions (BSS) with low chloride content whereas BSS may cause hyperkalemia. We aim to compare the safety and efficacy of normal saline (NS), Ringer’s lactate (RL) and Plasmalyte (PL) on acid-base balance and electrolytes during living donor kidney transplantation.Materials and methodsPatients were randomized to NS group (n = 60), RL group (n = 60) and Plasmalyte group (n = 60). Arterial blood samples were collected for acid-base analysis after induction of anaesthesia (T0), prior to clamping the iliac vein (T1), 10 minutes after reperfusion of the donated kidney (T2) and at the end of surgery (T3). In addition, serum creatinine and 24-hour urine output were recorded on postoperative days one, two and seven.ResultsThere was a statistically significant difference (p < 0.001) in the pH at the end of surgery between the three groups with the NS group being more acidotic (pH 7.29 ± 0.06, 95% CI 7.27-7.32), although this was not clinically relevant. This was explainable by the parallel increase in chloride in the NS group. Early postoperative graft functions in terms of serum creatinine, urine output and graft failure requiring dialysis were not significantly different between the groups.ConclusionBalanced salt solutions such as Plasmalyte and Ringer’s lactate are associated with better pH and chloride levels compared to normal saline when used intraoperatively in renal transplant patients. This difference, however, does not appear to have any bearing on graft function. Plasmalyte seems to maintain a better acid-base and electrolyte balance, especially during the postreperfusion period.

Expert consensus on the use of human serum albumin in critically ill patients.

Expert consensus on the use of human serum albumin in critically ill patients.

P0658 / #2080: COMPARISON OF CUMULATIVE FLUID INTAKE, FLUID BALANCE, AND BLOOD LACTATE LEVEL AFTER FLUID RESUSCITATION IN PEDIATRIC DENGUE SHOCK USING RINGER LACTATE AND HYPERTONIC LACTATE SOLUTION

Aims & Objectives: To compare the effect of Ringer Lactate (RL) vs hypertonic sodium lactate (HSL) on fluid accumulation, fluid balance, blood lactate and lactate clearance as reflection of restoration of tissue perfusion. Methods: A retrospective study based on year 2010 data of children age 2-14 yrs suffered from DSS newly treated in Department of Child Health, Hasan Sadikin Hospital, Bandung, Indonesia. Early fluid resuscitation applied with either HSL for 12 hours (5 mL/kgBW in 15 minutes, followed by 1 mL/kg/h for 12 hours, then changed by RL 1 mL/kgBW/hr for 12 hours) or RL (20 mL/kgBW in 15 minutes, then followed by decreasing dose of 10, 7, 5, and 3 mL/kgBW/hr every 3 hour within 12 hours). We searching for shock recovery, serial fluid-in and urine output, and blood lactate. Of 50 patients, 46 (24 and 22 patients in HSL and RL groups respectively) are analyzed. Results: Hemodynamic recovery faster in HSL group, fluid accumulation was two third higher in RL group. Near zero fluid balance were achieved within 12 hours by HSL group. We found obvious palpebral edema in all RL group and slightly in HSL group. Moreover, HSL might avoid reperfusion injury and restore tissue perfusion reflected by highly significant decrease in lactate clearance. Blood lactate decreased highly significant in both groups (p<0.001), whereas in RL group, blood lactate tend to rebound at hour 12 and 24 (p=0.811). Conclusions: Small volume resuscitation with HSL tends recover faster in DSS, avoid fluid accumulation, restore tissue perfusion and avoid reperfusion injury.

SHORTEN PREOPERATIVE FASTING AND INTRODUCING EARLY EATING ASSISTANCE IN RECOVERY AFTER GASTROJEJUNAL BYPASS?

ABSTRACT Rational: The metabolic response to surgical trauma is enhanced by prolonged preoperative fasting, contributing to increased insulin resistance. This manifestation is more intense on the 1st and 2nd postoperative days and is directly proportional to the size of the operation. Aim:To compare whether preoperative fasting abbreviation and early postoperative refeeding associated with intraoperative and postoperative fluid restriction interfere in the evolution of patients undergoing gastrojejunal bypass. Methods:Eighty patients indicated for Roux-en-Y gastrojejunal bypass were selected. They were randomly divided into two groups: Ringer Lactate (RL) group, who underwent a 6 hours solids fasting, with the administration of 50 g of maltodextrin in 100 ml of mineral water 2 hours before the beginning of anesthesia; and Physiologic Solution (PS) group, who underwent a 12 hours solids and liquids fasting. Anesthesia was standardized for both groups. During the surgical procedure, 1500 ml of ringer lactate solution was administered in the RL and 2500 ml of physiological solution (0.9% sodium chloride) in the PS. In both groups, the occurrence of bronchoaspiration was analyzed during intubation, and the residual gastric volume was measured after opening the abdominal cavity. In the postoperative period in Group RL, patients started a liquid diet 24 hours after the end of the operative procedure; whilst for PS group, fasting was maintained for the first 24 hours, it was prescripted 2000 ml of physiological solution and a restricted liquid diet after 36 hours. Each patient underwent CPK, insulin, sodium, potassium, urea, creatinine, PaCO2, pH and bicarbonate dosage in the immediate postoperative period, and 48 hours later, the exams were repeated. Results:There were no episodes of bronchoaspiration and gastrojejunal fistulas in either group. In the analysis of the residual gastric volume of the PS and RL groups, the mean volumes were respectively 16.5 and 8.8, which shows statistical significance between the groups. In laboratory tests, there was no difference between groups in sodium; PS group showed a higher level of serum potassium (p=0.029); whilst RL group showed a higher urea and creatinine values; CPK values were even for both; PS group demonstrated a higher insulin level; pH was higher in PS group; sodium bicarbonate showed a significant difference at all times; PaCO2 values in RL group was higher than in PS. In the analysis of the incidence of nausea and flatus, no statistical significance was observed between the groups. Conclusions:The abbreviation of preoperative fasting and early postoperative refeeding of Roux-en-Y gastrojejunal bypass with the application of ERAS or ACERTO Project accelerated the patient’s recovery, reducing residual gastric volume and insulin level, and do not predispose to complications.

Comparison of histidine-tryptophan-ketoglutarate solution versus ringer lactate as perfusion fluid in live donor renal transplant - A randomised controlled trial

Objective: Ringer's lactate (RL) was one of the perfusion fluid used in renal transplants, which were replaced by perfusion fluid with an intracellular composition like histidine-tryptophan-ketoglutarate (HTK) solution. These are preferred in cadaveric renal transplants. However, there are no guidelines for live-related donor renal transplant. We study whether HTK solution is better than RL solution, an extracellular composition fluid in preserving allograft in live-related donor renal transplantation. Materials and Methods: A single-blinded randomized trial comparing HTK solution and RL solution in 80 patients undergoing live-related donor renal transplantation from July 2017 to June 2018. The outcome was measured in serum cystatin C and plasma malondialdehyde (MDA) and serum creatinine for 30 days. Results: In 19 cases, surgeons preferred HTK solution as perfusion fluid due to the presence of multiple arteries; hence, these cases are removed from analysis due to deviation from the study protocol. Four patients in the HTK group and five patients in the RL group were excluded due to loss to follow-up. Recipient age, sex, and donor age, sex, and basic disease were comparable in both groups. The higher warm ischemia in the HTK group (5.58 min [standard deviation (SD) 1.44 min]) as compared to the RL group (5.00 min [SD 1.12 min]) with P 0.096. Similarly, the longer cold ischemia in the HTK group (82.00 min [SD 21.31 min]) as compared to the RL group (70.32 min [SD 24.56 min]) with P 0.783. 8.3% rejection in the HTK group and 17.9% rejection in the RL group. Serum cystatin C, marker of glomerular filtration was comparable, HTK group ((3.75 ± 1.98 mg/l) and RL (3.94 ± 1.68 mg/l) with P 0.714. The plasma MDA marker of ischemia-reperfusion injury was also comparable HTK group (80.16 ± 80.08 ng/ml) and RL group (61.50 ± 92.23 ng/ml) with a P 0.446. Fall in serum creatinine was significantly more in the HTK group than RL. At the end of 30 days, both groups had similar levels of serum creatinine level. Conclusion: Graft perfused by HTK solution and RL solution at our center had comparable 30-day outcomes. Although none of the differences was statistically significant, the HTK group had consistently better metrics in terms of fall in creatinine and serum cystatin C despite a trend to longer ischemia times and higher plasma MDA levels.