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Introduction: Preventing acid-base and electrolyte disturbance is crucial in coronary artery bypass graft (CABG) surgery, since any of these conditions can affect outcome. The type of crystalloid solution used during and after the surgery can affect these disturbances. Methods: In this study, 90 patients who candidates for CABG surgery were randomly allocated to either ringer's lactate (RL) or ringer's group. In order to provide essential blood volume before and after the start of CPB fluid administration with either ringer's or RL solution was started during operation and continued for 18 hours after the patient was transferred to ICU. ABG, serum electrolytes and Lactate level were measured before and at the end of CPB, upon arrival to the ICU, and 6, 12 and 18 hours after ICU admission and compared between the two groups. Results: Blood PH level was significantly different between the two groups upon arrival to ICU, 6 and 18 hours after ICU admission (P < 0.05) which was clinically closer to the normal range in the RL group. Serum bicarbonate level showed a significantly difference between the two groups (P < 0.05). There were no significantly differences between the two groups in terms of lactate level, serum electrolytes, blood loss, intake and output of fluids and blood products transfusion. Conclusion: In this study, ringer's lactate solution creates a more favorable acid-base balance without a significant increase in blood lactate level which is attributed to the buffering effect of existing lactate, and can be used as an appropriate alternative to ringer's solution during and after CABG. [ABSTRACT FROM AUTHOR]

High-molecular-weight linear polymers (HMWLPs) have earned the name "drag-reducing polymers" because of their ability to reduce drag in turbulent flows. Recently, these polymers have become popular in bioengineering applications. This study investigated whether the addition of HMWLP in a venoarterial extracorporeal circulation (ECC) model could improve microvascular perfusion and oxygenation. Golden Syrian hamsters were instrumented with a dorsal skinfold window chamber and subjected to ECC using a circuit comprised of a peristaltic pump and a bubble trap. The circuit was primed with lactated Ringer solution (LR) containing either 5 ppm of polyethylene glycol (PEG) with a low molecular weight of 500 kDa (PEG500k) or 5 ppm of PEG with a high molecular weight of 3,500 kDa (PEG3500k). After 90 min of ECC at 15% of the animal's cardiac output, the results showed that the addition of PEG3500k to LR improved microvascular blood flow in arterioles and venules acutely (2 h after ECC), whereas functional capillary density showed improvement up to 24 h after ECC. Similarly, PEG3500k improved venular hemoglobin O2 saturation on the following day after ECC. The serum and various excised organs all displayed reduced inflammation with the addition of PEG3500k, and several of these organs also had a reduction in markers of damage with the HMWLPs compared to LR alone. These promising results suggest that the addition of small amounts of PEG3500k can help mitigate the loss of microcirculatory function and reduce the inflammatory response from ECC procedures.NEW & NOTEWORTHY High-molecular-weight linear polymers have gained traction in bioengineering applications. The addition of PEG3500k to lactated Ringer solution (LR) improved microvascular blood flow in arterioles and venules acutely after extracorporeal circulation (ECC) in a hamster model and improved functional capillary density up to 24 h after ECC. PEG3500k improved venular hemoglobin O2 saturation and oxygen delivery acutely after ECC and reduced inflammation in various organs compared to LR alone.

Introduction: Mannitol, an osmotic diuretic solution, is commonly utilized in priming cardiopulmonary bypass (CPB) and can impact kidney function. This study was conducted to investigate the impact of mannitol use during CPB on kidney function in patients undergoing coronary artery bypass surgery. Methods: This randomized, double-blind clinical trial studied 90 patients undergoing coronary artery bypass surgery. In the control group (n=45), the prime solution included Ringer’s lactate, and in the intervention group (n=45), the prime solution had 200 ml of mannitol 20% and Ringer’s lactate. A P-value0.05). Additionally, there was no statistically significant difference between two groups in terms of CPB time, aortic cross-clamp time, length of time connected to mechanical ventilation, 30-day mortality, ICU, and hospital stay time (P>0.05). Furthermore, no statistically significant difference was observed between the two groups in serum creatinine levels (P=0.53) or BUN levels (P=0.13). The study also found no statistically significant difference in the diuresis rate between the two groups (P=0.10). Conclusion: The present study has shown that adding mannitol to the prime has no effect on kidney function, length of time connected to mechanical ventilation, length of stay in the ICU, or 30-day mortality. Therefore, it suggests that mannitol cannot be used as a preventative strategy for acute kidney injury after cardiac surgery.

BACKGROUND Delivery by caesarean section is common in recent times and subarachnoid block is the technique of choice due to its simplicity and reliability. However, it can cause hypotension which is associated with increased morbidity and mortality. Preloading the parturient with colloid is more effective than crystalloid in preventing the hypotension. Among the commercially available colloids 6% Pentastarch in 0.9% saline has the best safety profile. In this study, we compared the efficacy of 10ml/kg Ringer’s lactate to that of 10ml/kg 6% Pentastarch in preventing the incidence and severity of hypotension in parturients undergoing LSCS under SAB. MATERIAL AND METHODS After the ethical committee's approval, a randomized study was conducted on 114 parturients (aged between 20 -32 years) and divided into two groups. Group P - 6% Pentastarch 10ml/kg IV and Group R - Ringer’s Lactate 10ml/kg IV. Study drugs were administered intravenously over 20 minutes before the performance of the subarachnoid block. HR, SBP, DBP, MAP and SPO2 were noted every minute for the first 10 minutes, thereafter for every 5 mins till the end of surgery. RESULTS The mean HR of group P was better maintained than that of group R. A statistically significant fall in SBP was seen with group R more than group P at the 2nd, 4th, 6th, 7th, 10th and 40th minute. Group P had significantly less fall in DBP and MAP than group R. CONCLUSION Our study demonstrates that 6% Pentastarch is better preloading fluid than Ringer’s lactate in preventing hypotension in parturients undergoing elective caesarean section under subarachnoid block. [ABSTRACT FROM AUTHOR]

Introduction: Mannitol, an osmotic diuretic solution, is commonly utilized in priming cardiopulmonary bypass (CPB) and can impact kidney function. This study was conducted to investigate the impact of mannitol use during CPB on kidney function in patients undergoing coronary artery bypass surgery. Methods: This randomized, double-blind clinical trial studied 90 patients undergoing coronary artery bypass surgery. In the control group (n=45), the prime solution included Ringer's lactate, and in the intervention group (n=45), the prime solution had 200 ml of mannitol 20% and Ringer's lactate. A P -value<0.05 was considered significant. The primary endpoint of this study is renal function. Results: Demographic characteristics and risk factors were not significantly different between the two groups (P >0.05). Additionally, there was no statistically significant difference between two groups in terms of CPB time, aortic cross-clamp time, length of time connected to mechanical ventilation, 30-day mortality, ICU, and hospital stay time (P >0.05). Furthermore, no statistically significant difference was observed between the two groups in serum creatinine levels (P =0.53) or BUN levels (P =0.13). The study also found no statistically significant difference in the diuresis rate between the two groups (P =0.10). Conclusion: The present study has shown that adding mannitol to the prime has no effect on kidney function, length of time connected to mechanical ventilation, length of stay in the ICU, or 30-day mortality. Therefore, it suggests that mannitol cannot be used as a preventative strategy for acute kidney injury after cardiac surgery. [ABSTRACT FROM AUTHOR]

The recent identification of bacterial endotoxins in Ringer’s Lactate (RL) from a manufacturing batch by M/s. Vision Parenteral Pvt. Ltd. has raised significant concerns regarding the safety of intravenous solutions. These endotoxins, originating from Gram-negative bacteria, can trigger severe systemic inflammatory responses, worsening conditions like haemorrhagic shock and leading to organ dysfunction and increased mortality. The interaction between RL and endotoxins is particularly problematic, as it can exacerbate inflammation, disrupt fluid balance, and complicate metabolic and immune responses. This situation underscores significant gaps in pharmaceutical manufacturing practices and highlights the urgent need for stricter regulatory oversight and quality control. The healthcare community must reassess the use of RL in clinical settings, particularly in cases where endotoxin contamination could pose a significant risk, to protect patient health and safety.

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).

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. [ABSTRACT FROM AUTHOR]

Objective: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.Methods: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.Results: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.Conclusion: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.

Arthrocentesis is a minimally invasive technique used in treating various temporomandibular disorders. There are various lavaging agents and intra-articular injections used in arthrocentesis viz., Normal Saline (NS), Ringer’s Lactate (RL), Sodium Hyaluronate (SH), Platelet-rich Plasma (PRP), Non-steroidal Anti-inflammatory Drugs (NSAIDs) etc. The present review was conducted to compare the published literature about the efficacy of various lavaging agents and intra-articular injections used in arthrocentesis. It was found that NS and RL are currently the best proven agents for Temporomandibular Joint (TMJ) lavage. It has been observed that lavage combined with intra-articular injections produces better outcomes than lavage alone. Patients who received treatment with arthrocentesis in conjunction with Hylauronic Acid (HA) injection, displayed faster and more noticeable improvement in their perception of pain and maximal mouth opening.

Objectives: Given that no study has so far carefully examined the effects and benefits of crystalloids on the hemodynamic status and events during the surgery for lower limb orthopedic surgeries, the current study aimed to compare fluid therapy with normal saline (NS), Ringer (R), and Ringer's lactate (RL) during anesthesia on the hemodynamic status and events during lower limb elective orthopedic surgeries. Materials and Methods: This cross-sectional descriptive study was conducted in 2019 with the participation of 270 patients (three groups each including 90 subjects) who were scheduled for an elective lower limb orthopedic surgery in Imam Reza hospital of Tabriz. Patients received one of these serums of NS, R, and RL. Electrolytes were measured before and after the surgery. Finally, data were analyzed using ANOVA and chi-square tests. Results: Based on the results, there was no significant difference between the three groups in terms of hemoglobin, hematocrit, sodium, calcium, potassium, chlorine, albumin, creatinine, urea, bicarbonate, pH, and arterial oxygen levels (P>0.05), and RL serum had the least effect on all factors. Conclusions: In general, the administration of NS, R, and RL in lower limb orthopedic surgeries did not result in significant differences although RL had the least adverse effects and was associated with better results. [ABSTRACT FROM AUTHOR]

Arthrocentesis is a minimally invasive technique used in treating various temporomandibular disorders. There are various lavaging agents and intra-articular injections used in arthrocentesis viz., Normal Saline (NS), Ringer's Lactate (RL), Sodium Hyaluronate (SH), Platelet-rich Plasma (PRP), Non-steroidal Anti-inflammatory Drugs (NSAIDs) etc. The present review was conducted to compare the published literature about the efficacy of various lavaging agents and intra-articular injections used in arthrocentesis. It was found that NS and RL are currently the best proven agents for Temporomandibular Joint (TMJ) lavage. It has been observed that lavage combined with intra-articular injections produces better outcomes than lavage alone. Patients who received treatment with arthrocentesis in conjunction with Hylauronic Acid (HA) injection, displayed faster and more noticeable improvement in their perception of pain and maximal mouth opening. [ABSTRACT FROM AUTHOR]

Objective: 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. Methods: 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. Results: 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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

Background : : Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a common complication of therapeutic endoscopy. The aim of this trial was to determine whether a combination of rectal diclofenac and vigorous hydration with Ringer's lactate is superior to the corresponding individual treatments for preventing PEP in high-risk patients. Methods : : This randomized, open-label, controlled trial was conducted from August 2020 to January 2022. We included patients who were at high risk of developing PEP. Three intervention groups were made: group A, diclofenac sodium suppository (100 mg); group B, aggressive hydration with Ringer's lactate; group C, a combination of diclofenac and aggressive hydration. PEP was defined as a serum amylase level > 3 times the upper limit of normal with epigastric pain within 24 hours after endoscopic retrograde cholangiopancreatography. Results : : A total of 144 patients were included and 48 cases were randomized to each intervention group. The incidence of PEP was 8.3%, 10.4%, and 8.3% in groups A, B, and C, respectively. A personal history of alcohol consumption and more than one pancreatic duct guidewire cannulation were significantly associated with the development of PEP. Conclusion : : No difference in the incidence of PEP was observed with or without the use of aggressive hydration. Combining aggressive hydration with a rectal nonsteroidal anti-inflammatory drug for preventing PEP cannot be recommended.

Background Perioperative hyperglycemia can occur in surgical patients and may increase postoperative morbidity and mortality, especially in patients with diabetes. Therefore, we conducted the present study to evaluate whether the administration of 6% hydroxyethyl starch (HES)-130/0.4 increases blood glucose levels in patients with diabetes. Methods Forty patients undergoing lower limb surgery under spinal anesthesia were randomly allocated into two groups according to the fluids administered 20 min before spinal anesthesia (Group L, lactated Ringer’s solution; Group H, 6% HES-130/0.4). Patient characteristics, intraoperative variables, blood glucose levels, mean blood pressure (MBP), and heart rate (HR) were recorded at five time-points (0, 20, 60, 120, and 240 min). Results A total of 39 patients were analyzed (Group L, n = 20; Group H, n = 19). The amount of intraoperative fluid was significantly higher in Group L than in Group H (718.2 ml vs. 530.0 ml, P = 0.010). There were no significant differences in the changes in blood glucose levels, HR, or MBP between the two groups (P = 0.737, P = 0.896, and P = 0.141, respectively). Serial changes in mean blood glucose levels from baseline also showed no significant differences between the groups (P = 0.764). Conclusions There were no significant changes in blood glucose levels when lactated Ringer’s solution or 6% HES-130 was used. When compared to the lactated Ringer’s solution, no evidence that 6% HES-130/0.4 produces hyperglycemia in diabetic patients could be found. Further evaluation of larger populations is needed.

It has been documented that hemodynamic disturbances occur in hypovolemic patients. Therefore, the early management of hypovolemia is essential to achieve optimal outcomes. Blood gas, which changes rapidly during hemodynamic instability, can be used as a diagnostic approach for monitoring emergency patients. The objective of the current study was to evaluate the results of resuscitation with hydroxyethyl starch (HES) or lactated Ringer's solution (LR) on venous and arterial blood gas. In addition, the difference between venous and arterial blood gas parameters is investigated to assess the possibility of using venous blood gas analysis as a successor for arterial blood gas analysis in the resuscitation of hypovolemic dogs. Venous and arterial pH, PO2, PCO2, HCO3-, and base excess were analyzed at the end of each study stage as follow: 1) Establishment of anesthesia, 2) Blood collection to an arterial mean pressure of 40-50 mm Hg, 3) Maintaining dogs in a hypovolemic state, 4) Resuscitation with LR (group A) or HES (group B) in four steps, and 5) One hour after the final resuscitation step. Hypovolemia decreased the studied parameters, except venous PCO2, which showed a significant increase (p < 0.05). Fluid resuscitation returned the studied parameters to the control values as venous PCO2 in group A and HCO3- in group B showed a significant change in comparison with the control values (p < 0.05). We found that venous pH, HCO3-, and PCO2 can be used as less invasive and safer alternatives to similar arterial parameters to monitor the fluid resuscitation of hypovolemic dogs.

BackgroundResuscitation with crystalloid fluid is a cornerstone of pediatric septic shock treatment. However, the optimal type of crystalloid fluid is unknown. We aimed to determine the feasibility of conducting a pragmatic randomized trial to compare balanced (lactated Ringer's [LR]) with 0.9% normal saline (NS) fluid resuscitation in children with suspected septic shock.MethodsOpen-label pragmatic randomized controlled trial at a single academic children's hospital from January to August 2018. Eligible patients were >6 months to

Abstract Patients with acute pancreatitis (AP) often require ICU admission, especially when signs of multiorgan failure are present, a condition that defines AP as severe. This disease is characterized by a massive pancreatic release of pro-inflammatory cytokines that causes a systemic inflammatory response syndrome and a profound intravascular fluid loss. This leads to a mixed hypovolemic and distributive shock and ultimately to multiorgan failure. Aggressive fluid resuscitation is traditionally considered the mainstay treatment of AP. In fact, all available guidelines underline the importance of fluid therapy, particularly in the first 24–48 h after disease onset. However, there is currently no consensus neither about the type, nor about the optimal fluid rate, total volume, or goal of fluid administration. In general, a starting fluid rate of 5–10 ml/kg/h of Ringer’s lactate solution for the first 24 h has been recommended. Fluid administration should be aggressive in the first hours, and continued only for the appropriate time frame, being usually discontinued, or significantly reduced after the first 24–48 h after admission. Close clinical and hemodynamic monitoring along with the definition of clear resuscitation goals are fundamental. Generally accepted targets are urinary output, reversal of tachycardia and hypotension, and improvement of laboratory markers. However, the usefulness of different endpoints to guide fluid therapy is highly debated. The importance of close monitoring of fluid infusion and balance is acknowledged by most available guidelines to avoid the deleterious effect of fluid overload. Fluid therapy should be carefully tailored in patients with severe AP, as for other conditions frequently managed in the ICU requiring large fluid amounts, such as septic shock and burn injury. A combination of both noninvasive clinical and invasive hemodynamic parameters, and laboratory markers should guide clinicians in the early phase of severe AP to meet organ perfusion requirements with the proper administration of fluids while avoiding fluid overload. In this narrative review the most recent evidence about fluid therapy in severe AP is discussed and an operative algorithm for fluid administration based on an individualized approach is proposed.

ERCP has been established as a golden diagnostic and therapeutic modality in various pancreatobiliary diseases, including gallstones and malignancy. On the other hand, ERCP is a relatively invasive procedure with radiation hazards and major complications. Among the major complications, ERCP-related pancreatitis has been reported in more than 14.7% of high-risk patients, which might lead to extended hospitalization and a substantial burden for both patients and physicians. Recent guidelines have defined the high-risk factors for ERCP-related pancreatitis. In addition, several outstanding studies have shown that rectal non-steroidal anti-inflammatory drugs, aggressive hydration with lactated Ringer’s solution, and pancreatic stents can reduce ERCP-related pancreatitis in high-risk patients or all patients. A prevention algorithm for ERCP-related pancreatitis was provided based on advanced research.

It has been documented that hemodynamic disturbances occur in hypovolemic patients. Therefore, the early management of hypovolemia is essential to achieve optimal outcomes. Blood gas, which changes rapidly during hemodynamic instability, can be used as a diagnostic approach for monitoring emergency patients. The objective of the current study was to evaluate the results of resuscitation with hydroxyethyl starch (HES) or lactated Ringer's solution (LR) on venous and arterial blood gas. In addition, the difference between venous and arterial blood gas parameters is investigated to assess the possibility of using venous blood gas analysis as a successor for arterial blood gas analysis in the resuscitation of hypovolemic dogs. Venous and arterial pH, PO2, PCO2, HCO3-, and base excess were analyzed at the end of each study stage as follow: 1) Establishment of anesthesia, 2) Blood collection to an arterial mean pressure of 40-50 mm Hg, 3) Maintaining dogs in a hypovolemic state, 4) Resuscitation with LR (group A) or HES (group B) in four steps, and 5) One hour after the final resuscitation step. Hypovolemia decreased the studied parameters, except venous PCO2, which showed a significant increase (p < 0.05). Fluid resuscitation returned the studied parameters to the control values as venous PCO2 in group A and HCO3- in group B showed a significant change in comparison with the control values (p < 0.05). We found that venous pH, HCO3-, and PCO2 can be used as less invasive and safer alternatives to similar arterial parameters to monitor the fluid resuscitation of hypovolemic dogs. [ABSTRACT FROM AUTHOR]

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Patients with acute pancreatitis (AP) often require ICU admission, especially when signs of multiorgan failure are present, a condition that defines AP as severe. This disease is characterized by a massive pancreatic release of pro-inflammatory cytokines that causes a systemic inflammatory response syndrome and a profound intravascular fluid loss. This leads to a mixed hypovolemic and distributive shock and ultimately to multiorgan failure. Aggressive fluid resuscitation is traditionally considered the mainstay treatment of AP. In fact, all available guidelines underline the importance of fluid therapy, particularly in the first 24–48 h after disease onset. However, there is currently no consensus neither about the type, nor about the optimal fluid rate, total volume, or goal of fluid administration. In general, a starting fluid rate of 5–10 ml/kg/h of Ringer's lactate solution for the first 24 h has been recommended. Fluid administration should be aggressive in the first hours, and continued only for the appropriate time frame, being usually discontinued, or significantly reduced after the first 24–48 h after admission. Close clinical and hemodynamic monitoring along with the definition of clear resuscitation goals are fundamental. Generally accepted targets are urinary output, reversal of tachycardia and hypotension, and improvement of laboratory markers. However, the usefulness of different endpoints to guide fluid therapy is highly debated. The importance of close monitoring of fluid infusion and balance is acknowledged by most available guidelines to avoid the deleterious effect of fluid overload. Fluid therapy should be carefully tailored in patients with severe AP, as for other conditions frequently managed in the ICU requiring large fluid amounts, such as septic shock and burn injury. A combination of both noninvasive clinical and invasive hemodynamic parameters, and laboratory markers should guide clinicians in the early phase of severe AP to meet organ perfusion requirements with the proper administration of fluids while avoiding fluid overload. In this narrative review the most recent evidence about fluid therapy in severe AP is discussed and an operative algorithm for fluid administration based on an individualized approach is proposed. [ABSTRACT FROM AUTHOR]

Background: 0.9% saline commonly used for resuscitation of septic patients might induce biochemical changes leading to detrimental effects. Ringer's lactate being a balanced crystalloid might be beneficial in such a scenario. Objectives: We undertook this study to explore in detail the effect of these fluids in the resuscitation of septic patients, and risks and benefits these two fluids would have on the overall prognosis of patients. Methods: This was an open-label randomized controlled trial undertaken in emergency medical services attached to the department of medicine at a tertiary care teaching hospital. One hundred sixty adult (⩾18 years old) medical patients admitted with the diagnosis of sepsis fulfilling eligibility criteria were included. They were randomly assigned to receive 0.9% saline or ringer's lactate. These fluids were given for the initial 24 h only, and after then, the type of fluid given was based on treating physician discretion. Various biochemical parameters were measured at baseline and various time points during the hospital stay. The primary outcome was to find out the incidence of hyperchloremia at 24 h from the time of randomization and during the hospital stay. The secondary outcomes were incidence of acute kidney injury, need for renal replacement therapy; differences in pH, bicarbonate, serum lactate, coagulation parameters, sequential organ failure assessment scores at various time points; and hospital/30-day mortality. Results: The baseline characteristics in both groups were comparable. At admission, each group had a serum chloride value which was comparable (p value: 0.595); however, at 24 and 48 h, a statistically significant difference was noticed, with 0.9% saline group having a higher mean serum chloride value (113.66 ± 10.04 v/s 108.98 ± 8.04 mEq/L, p value: 0.001 at 24 h) and (114.75 ± 9.51 v/s 111.12 ± 7.84 mEq/L, p value: 0.022 at 48 h). At 24 and 48 h post-randomization, the incidence of hyperchloremia was significantly higher in the 0.9% saline group (at 24 h, 0.9% saline: 75.0% v/s Ringer's lactate: 48.8%, p value: 0.001 and at 48 h, 0.9% saline: 77.2% v/s Ringer's lactate: 60.3%, p value: 0.022), although there was no difference in the incidence of hyperchloremia recorded during the hospital stay. Acute kidney injury incidence at 24 and 48 h post-randomization was significantly higher in the 0.9% saline group (at 24 h, 0.9% saline: 23.8% v/s Ringer's lactate: 10.0%, p value: 0.020 and at 48 h, 0.9% saline: 29.1% v/s Ringer's lactate: 15.4%, p value: 0.039). No significant differences in other secondary outcomes were observed. Conclusion: Higher incidence of hyperchloremia and a higher rate of acute kidney injury at 24 and 48 h after randomization were noted in the 0.9% saline group. [ABSTRACT FROM AUTHOR]

Background Normal saline solution (NSS) has been the fluid of choice for renal transplant patients, but it can lead to hyperchloremic acidosis and hyperkalemia. This study was performed to compare the safety profile of low-chloride solutions with that of NSS in renal transplant patients. Methods We conducted a systemic review search on PubMed, Embase, and the Central Cochrane Registry. Randomized clinical trials (RCTs) and matched cohort studies involving NSS as the control arm and low-chloride solutions as an intervention arm were chosen. The standardized mean difference for continuous variables, the odds ratio (OR) for discrete variables, and a 95% confidence interval (CI) for effect sizes were used. A p-value of

Background & objective: Normal saline is the most commonly used fluid in traumatic brain injury (TBI) patients both in resuscitation and maintenance since long time but associated with hyperchloremic metabolic acidosis. Balanced salt solutions (BSS) are recently developed with favorable outcome in resuscitation and intraoperative as a maintenance fluid. We compared normal saline and BSS as maintenance fluids in TBI patients admitted to intensive care unit. Methodology: After institutional ethical committee approval and written informed consent from patients' relatives, 100 patients who meet inclusion criteria were randomly divided into two equal groups; Group NS: to receive normal saline as a maintenance fluids and Group BSS: to receive BSS as a maintenance fluid. Data of serum electrolyte and acid base status were collected on day 1, 3, 5, 7 and 14. Patient outcome was evaluated on day-8. Data was analyzed with appropriate statistical tests. The P < 0.05 indicated that the difference was significant. Results: In both groups pH gradually increased over time and was more alkaline in normal saline group. Base excess was comparable between two groups. In normal saline group, serum sodium and chloride increased gradually and reached on the higher side on day-14, while potassium level dropped to a lower side. Twenty-eight days mortality was more in Group NS than the Group BSS. Conclusion: Balanced salt solution causes lesser alterations in acid base and electrolyte status than the normal saline and is associated with more favorable outcome. [ABSTRACT FROM AUTHOR]

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.

Abstract Background Induction of general anesthesia increases the hemodilution resulting from infusion of crystalloid fluid, which is believed to be due to slower distribution caused by arterial hypotension. When normal distribution returns is not known. Methods An intravenous infusion of 25 mL kg− 1 of Ringer’s lactate was infused over 30 min to 25 volunteers just after induction of general anesthesia for open abdominal hysterectomy. A two-volume model was fitted to the repeated measurements of the blood hemoglobin concentration and the urinary excretion using mixed-effects modelling software. Individual-specific covariates were added in sequence. Results Distribution of infused fluid was interrupted during the first 20 min of the infusions. During this time 16.6 mL kg− 1 of lactated Ringer’s had been infused, of which virtually all remained in the circulating blood. Thereafter, the fluid kinetics was similar to that previously been found in awake volunteers except for the elimination rate constant (k 10), which remained to be very low (0.86 × 10− 3 min− 1). Redistribution of infused fluid from the interstitium to the plasma occurred faster (higher k 21) when the arterial pressure was low. No covariance was found between the fixed parameters and preoperatively concentrated urine, the use of sevoflurane or propofol to maintain the anesthesia, or the plasma concentrations of two degradation products of the endothelial glycocalyx, syndecan-1 and heparan sulfate. Conclusions Induction of general anesthesia interrupted the distribution of lactated Ringer’s solution up to when 16.6 mL kg− 1 of crystalloid fluid had been infused. Plasma volume expansion during this period of time was pronounced. Trial registration Controlled-trials.com ( ISRCTN81005631 ) on May 17, 2016 (retrospectively registered).

AIM: To compare the difference between using Ringer's and Ringer's lactate(RL)solutions as irrigating solutions during phacoemulsification and investigate their effect on corneal endothelium.METHODS: This was a prospective interventional double blinded clinical study that included 100 eyes of 100 patients aged between 50 to 65 years suffering from a visually significant age-related cataract and scheduled for routine uncomplicated phacoemulsification. The included eyes were randomly divided into two equal groups(each group included 50 eyes). Group 1 received Ringer's solution and group 2 received Ringer's lactate as an irrigating solution.RESULTS: The first group with Ringer's solution had a mean age of 57.5±8 years and the second group with RL solution had a mean age of 58.6±9 years. After 3mo, endothelial cell density decreased in group 1 by a mean of 8.5%, and in group 2 by a mean of 3.6%(P=0.013). Additionally, central corneal thickness increased in group 1 by a mean of 6.9% and in group 2 by a mean of 1.5%(P=0.006). By correlating the percentage of change in pachymetry and specular microscopic parameters with volume of irrigation solution used, there was no significant correlation.CONCLUSION: The use of Ringer's lactate as an irrigating solution is associated with less endothelial cell loss postoperatively in comparison to Ringer's solution and also associated with decreased postoperative edema.

Background: Whether intraoperative use of hydroxyethyl starch (HES) solutions is associated with postoperative acute kidney injury (AKI) continues to be researched. Urinary neutrophil gelatinase-associated lipocalin (NGAL) is validated for early detection of AKI. Previous studies are limited and use empirically predefined volumes of HES solutions with serum creatinine as marker for AKI. Materials and Methods: Adults scheduled for orthopedic surgery under general anesthesia with >200–300 mL blood loss expected were included; 40 were randomized to receive 6% HES 130/0.4 (tetrastarch) (group HES) or Ringer's lactate (group RL) boluses when stroke volume variation (SVV) >10% in supine or lateral position, or >14% in prone position. Incidence of early postoperative AKI using urinary NGAL (>100 ng/mL) was the primary outcome, and using derangement of serum creatinine was the secondary measure. Results: In 38 patients, intervention was completed, and incidence of AKI (postoperative urinary NGAL >100 ng/mL) among them was 0% in both groups. Patients with urinary NGAL >50 ng/mL were insignificantly higher for group RL versus group HES (6/19 vs. 4/19) (P = 0.461), as were those with incidence of AKI as per creatinine values (5/19 vs. 4/19) (P = 1.000). Group RL had significantly higher requirement of fluid (1211 ± 758 mL vs. 689 ± 394 mL) (P = 0.013) and lower cardiac index (P < 0.05) versus group HES. Conclusion: SVV-guided tetrastarch and Ringer's lactate do not result in postoperative AKI diagnosed by urinary NGAL >100 ng/mL; however, an insignificant trend for better renal functions as well as significantly more efficacious volume expansion and hemodynamic stability were seen with tetrastarch instead.

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. [ABSTRACT FROM AUTHOR]

Introduction: Appropriate early fluid resuscitation is ubiquitous for critically ill patients with metabolic acidosis. Owing to harmful effects of normal saline, commercially prepared balanced salt solutions are being used. However, there is no study comparing use of Ringer's lactate (RL) and commercially available balanced salt solutions in critically ill patients. Materials and methods: A randomized controlled trial was conducted during July 2016 to December 2017. Fifty adult patients admitted to intensive care unit with metabolic acidosis were randomized into group RL or group acetate solution (AC). Respective trial fluid was administered at 20 mL/kg/hour for first hour and 10 mL/kg/hour for second hour. Arterial blood gas analysis samples were taken 15 minutes apart. The fluid resuscitation was continued till pH got corrected to 7.3 or 2 hours, whichever was earlier. The primary aim was to compare time to correct metabolic acidosis in both the groups. The secondary outcomes were the extent of correction of metabolic acidosis, total volume of fluid used, and total cost per patient. Results: Demographic parameters, APACHE II score, and baseline investigations were comparable. The metabolic acidosis got corrected in 12 patients in group AC and 10 patients in group RL (p value = 0.66). The mean time for correction of metabolic acidosis was 57 ± 3.85 minutes in group RL and 56.25 ± 4.22 minutes in group AC (p value =0.95). The extent of correction of metabolic acidosis and total volume of fluid used was also comparable (p value = 0.05). However, the cost of fluid used was significantly higher in group AC (p value < 0.01). Conclusion: During administration of balanced salt solutions, RL or AC, in critically ill patients with metabolic acidosis, AC did not confer any advantage in time to or extent of correction of metabolic acidosis. Clinical significance: There is no difference in acid--base status with use of different types of balanced salt solutions for resuscitation in critically ill patients. [ABSTRACT FROM AUTHOR]

Background: Induction of general anesthesia increases the hemodilution resulting from infusion of crystalloid fluid, which is believed to be due to slower distribution caused by arterial hypotension. When normal distribution returns is not known. Methods: An intravenous infusion of 25 mL kg− 1 of Ringer's lactate was infused over 30 min to 25 volunteers just after induction of general anesthesia for open abdominal hysterectomy. A two-volume model was fitted to the repeated measurements of the blood hemoglobin concentration and the urinary excretion using mixed-effects modelling software. Individual-specific covariates were added in sequence. Results: Distribution of infused fluid was interrupted during the first 20 min of the infusions. During this time 16.6 mL kg− 1 of lactated Ringer's had been infused, of which virtually all remained in the circulating blood. Thereafter, the fluid kinetics was similar to that previously been found in awake volunteers except for the elimination rate constant (k10), which remained to be very low (0.86 × 10− 3 min− 1). Redistribution of infused fluid from the interstitium to the plasma occurred faster (higher k21) when the arterial pressure was low. No covariance was found between the fixed parameters and preoperatively concentrated urine, the use of sevoflurane or propofol to maintain the anesthesia, or the plasma concentrations of two degradation products of the endothelial glycocalyx, syndecan-1 and heparan sulfate. Conclusions: Induction of general anesthesia interrupted the distribution of lactated Ringer's solution up to when 16.6 mL kg− 1 of crystalloid fluid had been infused. Plasma volume expansion during this period of time was pronounced. Trial registration: Controlled-trials.com (ISRCTN81005631) on May 17, 2016 (retrospectively registered). [ABSTRACT FROM AUTHOR]

Context: It is common practice to avoid lactate-containing intravenous fluids in diabetic patients as it was hypothesized to cause hyperglycaemia by the conversion of lactate to glucose by hepatic gluconeogenesis. However, absence of sound theoretical basis, conflicting reports from numerous clinical trials and improved understanding of biochemistry have necessitated a closer scrutiny of this hypothesis. Aims: The present study aims to determine the effect of 0.9% saline and Ringer's lactate on blood glucose levels in the fasting diabetic surgical patients receiving spinal anaesthesia. Settings and design: The study is a prospective randomized trial conducted on adult patients aged 30 -- 85 years with well-controlled type 2 diabetes mellitus receiving spinal anaesthesia. Methods and material: 120 patients with well-controlled type 2 diabetes mellitus receiving spinal anaesthesia were randomized to receive either 1 litre of 0.9% saline or Ringer's lactate. Blood glucose levels were recorded using a glucometer by the pinprick method before and after infusion of 1 litre of the selected intravenous fluid. Statistical analysis: Data analysis was done using SPSS statistical package - Version 22.0. Student's unpaired 't' test was used to test the significance of difference between quantitative variables. A 'p' value less than 0.05 was taken to denote statistical significance. Results: Mean change in blood glucose levels after infusion of the intravenous fluid in 0.9% saline and Ringer's lactate groups were 3.68±15.2 mg/dl and - 0.15±16.5 mg/dl, respectively. The difference between the two groups was not statistically significant with a 'p' value of 0.188. Conclusions: Ringer's lactate solution, when compared to 0.9% saline, does not cause significant change in the mean blood glucose levels in fasting diabetic patients receiving spinal anaesthesia. [ABSTRACT FROM AUTHOR]

Background and Purpose of the Study: Two of the most critical factors affecting the prognosis of an avulsed tooth after replantation are extraoral dry time and the storage medium in which the tooth was placed before treatment could be rendered. The ability of a storage medium to support cell viability of the periodontal ligament (PDL) can be an important factor in the prognosis, and thus, the aim of this study was to evaluate the efficacy of commonly available storage media. Materials and Methods: Cultured PDL cells of sixty freshly extracted human teeth were randomly divided into four groups of 15 each, Group I: Electral solution, Group II: Ringer's lactate, Group III: Oral rehydration salt liquid (ORS-L), and Group IV: Coconut water. Samples in each group were further divided into three subgroups depending on the time duration they were placed in the storage medium, i.e., 1, 4, and 8 h. Further these samples were subjected to Collagenase assay, the cells were stained with trypan blue and viable PDL cells were counted under light microscope. Results: Statistical analysis showed that Group II demonstrated significantly (P < 0.001) more viable PDL cells in than Groups IV and I, least viable PDL cells are seen with Group III samples. Conclusion: Ringer's lactate maintained highest PDL cell viability followed by coconut water, electoral solution, and ORS-L at various time intervals. More studies with large samples are required to prove the efficacy of Ringer's lactate as viable storage media.

Objective: To compare ringer's lactate and normal saline fluid replacement in pediatric patients with acute watery diarrhoea in terms of mean serum bicarbonate, potassium and pH. Study Design: Quasi experimental study. Place and Duration of Study: This study was conducted at the department of Pediatrics, Pak Emirates Military Hospital, Rawalpindi from Feb 2015 to Jul 2015. Methodology: This study involved 206 children of both genders aged between 1-5 years with watery diarrhoea and severe dehydration. These patients were randomly divided into two treatment groups each comprising of 103 patients. Patients in group-A received ringer's lactate while group-B patients were given normal saline as replacement fluids. Results: The mean age of the patients was 3.34 ± 1.19 years and there were 112 (54.4%) male and 94 (45.6%) female patients. Both the groups were comparable in terms of mean age (p=0.861) and gender distribution (p=0.576). After 6 hours of initiating fluid therapy, mean serum bicarbonate (13.61 ± 2.41 vs. 9.72 ± 2.07 meq/l; p<0.001) and mean blood pH (7.46 ± 0.02 vs. 7.38 ± 0.03; p<0.001) were significantly higher in children treated with ringer's lactate as compared to normal saline. While there was no significant difference between the two groups (4.35 ± 0.61 vs. 4.27 ± 0.58 meq/l; p=0.319) in terms of mean serum potassium level. Conclusion: Fluid replacement with ringer's lactate was superior to normal saline in terms of significantly higher mean serum bicarbonate and mean blood pH after 6 hours of initiating therapy while it was equally safe and only caused insignificant increase in mean serum potassium level. [ABSTRACT FROM AUTHOR]

Background: Fluid management during intracranial surgery is an important concern. The type of fluid used can have biochemical and metabolic effects during intraoperative management. However, it is yet to be known whether biochemical and metabolic effects have an influence on the clinical outcome of a patient.Objective: A prospective evaluation of the effects of normal saline (NS), Ringer's lactate (RL), and a combination of NS and RL on the biochemical, metabolic, and clinical outcomes in patients undergoing intracranial tumor surgery was carried out.Materials and Methods: Ninety patients undergoing elective intracranial tumor surgery were randomized to receive NS, RL, or a combination of NS and RL. The biochemical and metabolic parameters were studied at different time points in the intraoperative and postoperative period. The hemodynamic parameters, brain relaxation score at the time of bone flap elevation, postoperative complications, and the duration of hospital stay were the clinical outcome variables of our study.Results: The use of NS was associated with hyperchloremic metabolic acidosis and ionic hypocalcemia. RL caused significant hyponatremia and increase in serum lactate levels. The combination of NS and RL has least influence on biochemical and metabolic parameters. The effects of three fluids were similar on the hemodynamics, brain relaxation score, as well as on postoperative complications and the duration of postoperative hospital stay.Conclusion: There are variable effects of NS, RL, or its combination on the biochemical and metabolic parameters in patients undergoing intracranial tumor surgery. However, the clinical outcome of the patients remains similar. [ABSTRACT FROM AUTHOR]

Background Dengue hemorrhagic fever (DHF) infection causes hepatocelullar impairment. In management of DHF, World Health Organization (WHO) recommends the crystalloids Ringer’s acetate (RA) or Ringer’s lactate (RL), which are similar in composition to plasma. Acetate in RA is not metabolized in the liver, hence not burdening the liver, whereas lactate in RL is metabolized mostly in the liver, thus placing a burden on the liver. Objective To compare aminotransferase changes as markers of hepatocellular impairment subsequent to the use of RA and RL in the management of DHF with and without shock. Methods This study was a double-blind randomized controlled trial on DHF patients aged 1-18 years in Cipto Mangunkusumo Hospital who had not received prior treatment with crystalloids or colloids. Subjects were randomly assigned to receive either RA or RL intravenously. Aminotransferase levels were examined on the first, second and third weeks from the onset of fever. Results Ninety-two patients who fulfilled inclusion criteria were enrolled in this study, consisting of those without and with shock. Mean transaminase levels of patients without shock in the RA and RL groups did not differ significantly. Mean transaminase levels of patients with shock in the RA group were lower than those in the RL group, but this difference was not significant statistically. Mean alteration of transaminase levels in patients with and without shock were not significantly different. Conclusion In DHF without shock, there is no significant differ- ence between aminotransferase level changes of patients receiv- ing RA and RL solutions. In DHF with shock, aminotransferase levels of patients receiving RA tend to be lower than those receiv- ing RL, but this difference is insignificant

Background and Aims: Lactate levels predict outcomes after hepatectomy. We compared metabolic effects of lactated versus lactate free solutions in living donor hepatectomy. Methods: Consecutive right lobe donors (n = 53) were alternatively allotted to lactated Ringer′s solution and normal saline (Group L-control) or acetated crystalloid (Sterofundin B Braun ® Group S -study group) in an observational prospective randomised study. The primary outcome measure was lactate level, and secondary outcomes were base excess, bicarbonate, glucose and chloride intra- and post-operatively. Mann-Whitney and Chi-square tests were used for analysis. Results: The intraoperative, post-operative lactate levels and the time for normalisation were comparable. Group L had significantly lower intraoperative bicarbonate levels (mmol/L) at 6 and 8 h (20.0 ± 2.14 vs. 21.3 ± 1.6, P = 0.0471; 18.68 ± 2.04 vs. 20.39 ± 17, P = 0.002), base excess at 4 and 6 h (mmol/L) (−3.64 ± 2.73 vs. −3.0 ± 1.52, P = 0.031; −6.64 ± 2.76 vs. −4.35 ± 1.7 P = 0.006). The intraoperative chloride levels (mmol/L) were higher in group L at 4 and 8 h (108 ± 5.9 vs. 105.99 ± 2.76, P = 0.0471; 109.51 ± 3.86 vs. 106.93 ± 3.09, P = 0.002). Intraoperative glucose (mg/dL) at 6 h was higher in group L, 160.55 ± 31.52 vs. 145.5 ± 24.29, P = 0.043. The highest post-operative chloride (mmol/L) was higher in Group L (112.3 ± 3.86 vs. 109.81 ± 3.72, P = 0.034). Post-operative base excess and bicarbonate showed an improved profile in Group S (−7.37 ± 2.99 vs. −5.06 ± 1.71 P = 0.001 and 17.79 ± 2.23 vs. 19.68 ± 1.51 P = 0.005). Conclusion: Acetated fluids were associated with higher levels of bicarbonate, lesser base deficit, glucose and chloride but no difference in lactate levels in comparison with Ringer′s lactate and normal saline in living donor hepatectomy.

Background: Third space fluid loss is one of the hallmarks of the pathophysiology of acute pancreatitis (AP) contributing to complications, including organ failure and death. We conducted a systematic review of literature to determine the ideal fluid resuscitation in the early management of AP, primarily comparing aggressive versus moderate intravenous fluid resuscitation (AIR vs MIR)., Methods: A systematic review of major reference databases was undertaken. Meta-analysis was performed using random-effects model. Bias was assessed using Cochrane risk of bias and ROBINS-I tools for randomized and non-randomised studies, respectively., Results: Twenty studies were included in the analysis. Though there was no significant difference in mortality between AIR and MIR groups (8.3% versus 6.0%; p = 0.3), AIR cohort had significantly higher rates of organ failure (p = 0.009), including pulmonary (p = 0.02) and renal (p = 0.01) complications. Similarly, there was no difference in mortality between normal saline (NS) and Ringer's lactate (RL) (3.17% versus 3.01%; p = 0.23), though patients treated with NS had a significantly longer length of hospital stay (LOS) (p = 0.009)., Conclusions: Current evidence appears to support moderate intravenous resuscitation (level of evidence, low) with RL (level of evidence, moderate) in the early management of AP., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)

Objective: To define a reference chart comparing pressure drop vs. flow generated by a set of arterial cannulae currently utilized in cardiopulmonary bypass conditions in pediatric surgery., Methods: Cannulae from two manufacturers were selected considering their design and outer and inner diameters. Cannula performance was evaluated in terms of pressure drop vs. flow during simulated cardiopulmonary bypass conditions. The experimental circuits consisted of a Jostra HL-20 roller pump, a Quadrox-i pediatric oxygenator (Maquet Cardiopulmonary AG, Rastatt, Germany), and a custom pediatric tubing set. The circuit was primed with lactated Ringer's solution only (first condition) and with human packed red blood cells added (second condition) to achieve a hematocrit of 30%. Cannula sizes 8 to 16 Fr were inserted into the cardiopulmonary bypass circuit with a "Y" connector. The flow was adjusted in 100 ml/min increments within typical flow ranges for each cannula. Pre-cannula and post-cannula pressures were measured to calculate the pressure drop., Results: Utilizing a pressure drop limit of 100 mmHg, our results suggest a recommended flow limit of 500, 900, 1400, 2600, and 3100 mL/min for Braile arterial cannulae sizes 8, 10, 12, 14, and 16 Fr, respectively. For Medtronic DLP arterial cannulae sizes 8, 10, 12, 14, and 16 Fr, the recommended flow limit is 600, 1100, 1700, 2700, and 3300 mL/min, respectively., Conclusion: This study reinforces discrepancies in pressure drop between cannulae of the same diameter supplied by different manufacturers and the importance of independent translational research to evaluate components' performance.

Contrast-induced nephropathy (CIN) is one the most important renal complications following contrast injection in percutaneous coronary intervention. We compared the protective effect of normal saline (NLS), Ringer's lactate (RL), and sodium bicarbonate (Bi). In this study, patients with coronary angiography indication were divided into three groups by simple randomization method: NLS, RL, and Bi solution groups. Creatinine (Cr) alterations, glomerular filtration rate, and urine pH were evaluated prior and after the procedure. Data were analyzed with SPSS and P value less than 0.05 was taken as significant. In this study, 300 patients [150 men (50%), mean age 59.1 ± 10.6 years] were studied. The CIN incidence overall was 10% (30 patients): 8.3% (8 patients) in NLS; 16.5% (17 patients) in RL; and 5% (5 patients) in Bi group. It was significantly different among three groups (P = 0.018), and CIN incidence was significantly lower in Bi vs. RL group (P = 0.012). Baseline Cr clearance was higher in patients who developed CIN (78.4 ± 26.0 vs. 69.8 ± 21.6 mL/dL, P = 0.044). Urine pH after trial in CIN group was lower than the patients without CIN (5.5 ± 1.4 vs. 6.3 ± 1.8 mL/dL, P = 0.024). Higher urine pH and its change during study were seen in Bi group (P < 0.05). Cr at the initiation of study and the use of RL vs. Bi may be prognostic factors in CIN progression (P < 0.002). Sodium barcarbonate as fluid had more protective effect than NSL or RL on prevention of CIN in patients undergoing coronary angiography. The risk factors for CIN in our study were higher baseline serum Cr and use of RL as hydration fluid. [ABSTRACT FROM AUTHOR]

Background: Whether intraoperative use of hydroxyethyl starch (HES) solutions is associated with postoperative acute kidney injury (AKI) continues to be researched. Urinary neutrophil gelatinase-associated lipocalin (NGAL) is validated for early detection of AKI. Previous studies are limited and use empirically predefined volumes of HES solutions with serum creatinine as marker for AKI. Materials and Methods: Adults scheduled for orthopedic surgery under general anesthesia with >200-300 mL blood loss expected were included; 40 were randomized to receive 6% HES 130/0.4 (tetrastarch) (group HES) or Ringer's lactate (group RL) boluses when stroke volume variation (SVV) >10% in supine or lateral position, or >14% in prone position. Incidence of early postoperative AKI using urinary NGAL (>100 ng/mL) was the primary outcome, and using derangement of serum creatinine was the secondary measure. Results: In 38 patients, intervention was completed, and incidence of AKI (postoperative urinary NGAL >100 ng/mL) among them was 0% in both groups. Patients with urinary NGAL >50 ng/mL were insignificantly higher for group RL versus group HES (6/19 vs. 4/19) (P = 0.461), as were those with incidence of AKI as per creatinine values (5/19 vs. 4/19) (P = 1.000). Group RL had significantly higher requirement of fluid (1211 ± 758 mL vs. 689 ± 394 mL) (P = 0.013) and lower cardiac index (P < 0.05) versus group HES. Conclusion: SVV-guided tetrastarch and Ringer's lactate do not result in postoperative AKI diagnosed by urinary NGAL >100 ng/mL; however, an insignificant trend for better renal functions as well as significantly more efficacious volume expansion and hemodynamic stability were seen with tetrastarch instead. [ABSTRACT FROM AUTHOR]

Background: Little is known about the turnover of crystalloid fluids infused in patients with acute systemic inflammation. We hypothesised that systemic inflammation would be associated with altered distribution and elimination of Ringer's lactate solution (volume kinetics).Methods: Ringer's lactate solution (15 ml kg-1) was infused intravenously over 35 min in patients undergoing cholecystectomy (n=20) or appendectomy (n=20) starting before induction of general anaesthesia. Blood samples and urine were collected over the following 2 h. Plasma concentrations of inflammatory (tumour necrosis factor-α, interleukin-10, and C-reactive protein) and endothelial damage (syndecan-1) biomarkers were quantified by enzyme-linked immunosorbent assay. The volume kinetics was studied using mixed-effect modelling.Results: Ongoing surgery (duration: 30-45 min) increased the rate constant for fluid transfer from the plasma to the extravascular space (k12; from 32 to 57×10-3 min-1; P<0.001), and decreased the elimination rate constant (k10; from 5.3 to 0.6×10-3 min-1; P<0.001). A lower mean arterial pressure was associated with reduced elimination, independent of conscious/anaesthetised state. The redistribution of fluid back to the plasma occurred more slowly in the group with appendicitis (P<0.02), in whom higher plasma concentrations of C-reactive protein were measured [median: 38.1 (range 1.8-143.6) vs 1.3 (0.1-159.0) μg ml-1; P<0.001]. However, no biomarkers for inflammation or endothelial damage were significantly associated covariates in the kinetic model.Conclusions: No association was found between the volume kinetics of Ringer's lactate solution and the degree of inflammation as indicated by established biomarkers in patients with cholecystitis or appendicitis. However, the rate of elimination was greatly retarded by general anaesthesia in both groups.Clinical Trial Registration: ChiCTR-IOR-15006063. [ABSTRACT FROM AUTHOR]

Background: Addition of glucose in the intraoperative fluid is a routine practice in infants. Under general anesthesia, due to neuroendocrine stress response, this could result in overt hyperglycemia. Aims: The aim of this study was to find whether the addition of 2% dextrose to Ringer's lactate (RL) caused hyperglycemia compared to no addition of dextrose to RL. Settings and Designs: This prospective randomized study was conducted in 100 infants undergoing facial cleft surgery at a tertiary care institution. Subjects and Methods: Group D received RL with 2% dextrose and Group R received RL without the addition of dextrose. Blood sugars were measured at induction, 1 h and 2 h later. Hyperglycemia was defined as blood sugar >150 mg/dL and hypoglycemia as <70 mg/dL. Statistical Analysis Used: Pearson's Chi-square test, Paired t-test, Mann–Whitney test, and Independent sample t-test were used as applicable. Results: Baseline blood sugar was comparable in both groups. A significant increase in blood sugar values from baseline was seen in both groups, but the increase was significantly more in Group D at 60 min (136.5 ± 41.9 vs. 109.2 ± 20.5) and at 120 min (150.1 ± 45.5 vs. 123.1 ± 31.7). The incidence of hyperglycemia was 50% in Group D and 12% in Group R. No patient developed hypoglycemia intraoperatively. No significant correlation between blood sugar and hours of fasting was established. Conclusion: Routine addition of dextrose to RL is not essential during short surgeries under general anesthesia in infants, provided preinduction blood sugar level is >70 mg/dL and intraoperative sugars are periodically monitored. [ABSTRACT FROM AUTHOR]