Metabolic profile in right lobe living donor hepatectomy: Comparison of lactated Ringer′s solution and normal saline versus acetate based balanced salt solution - a pilot study

Abstract

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.

Effect of liberal versus restrictive fluid therapy on intraoperative lactate levels in robot- assisted colorectal surgery

“…[ 14 ] A study comparing Ringer's lactate with an acetate containing fluid in donor hepatectomy showed no differences in lactate, but an increased metabolic acidosis in the Ringer's lactate group. [ 15 ]…”

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

“…Acetated Ringer's solution as a new balanced salt solution, compared with slactated Ringer's solution, to maintai n a high levels of bicarbonate and reduce the amount of alkali deficiency, less lead to hyperglycemia (Kumar et al, 2016). And sodium acetate metabolism is seldom dependent on the liver (Kumar et al, 2016). Acetated Ring er's solution compared to lactated Ringer's solution can significantly reduce the body's inflammatory response (Cai et al, 2016).…”

Evaluation of the metabolic profile of ringer lactate versus ringer acetate in nondiabetic patients undergoing major surgeries

“…Higher lactate levels in Ringer acetate group are different from the previous studies conducted by Kumar et al . [ 8 ] in donor hepatectomy and Hadimioglu et al . [ 7 ] in kidney transplantation.…”

“…Kumar et al . [ 8 ] concluded that the acetated fluids had higher bicarbonate, lesser base deficit, glucose, and chloride as well as lower lactate than Ringer's lactate with normal saline. Hadimioglu[ 9 ] et al .…”