Perioperative buffered versus non-buffered fluid administration for surgery in adults

Abstract

The administration of buffered fluids to adult patients during surgery is equally safe and effective as the administration of non-buffered saline-based fluids. The use of buffered fluids is associated with less metabolic derangement, in particular hyperchloraemia and metabolic acidosis. Larger studies are needed to assess robust outcomes such as mortality.

Balanced versus isotonic saline resuscitation—a systematic review and meta-analysis of randomized controlled trials in operation rooms and intensive care units

“…Retrospective or observational studies (23) were excluded, as such preventing the risk for bias. Also studies that compared balanced solutions along with colloids and gelatins (24,25). The RCTs used in the meta-analysis were all of high quality, and included operation room as well as ICU patients allowing comparisons in the two patient groups those were most often subjected to fluid resuscitation.…”

“…In healthy volunteers, hyperchloremia is associated with a decrease in mean renal artery flow velocity and renal cortical tissue perfusion (26), and an increased time to urination and decreased urine production (26,27). Observational studies in ICU patients suggest an increased mortality in association with hyperchloremia (28), coagulopathy (29), decreased organ perfusion (30) and gastro-intestinal symptoms (8), as well as increased need for transfusion of blood products (24,31,32). Thus, balanced solutions could have a strong potential to affect outcome of patients with shock, who are frequently suffering from a pro-inflammatory and procoagulant state.…”

Drug-induced metabolic acidosis

“…It causes a dose-dependent hyperchloraemic metabolic acidosis. 20 Hyperchloraemia results from the chloride concentration of the solution which, at 154 mmol/L, is substantially higher than that of serum (around 100 mmol/L). Acidosis may be due to an unbalanced effect on the CO2/HCO3 -buffer system: HCO3 -is diluted while PCO2 is independently regulated by respiration.…”

Association Between Initial Fluid Choice and Subsequent In-Hospital Mortality During the Resuscitation of Adults With Septic Shock

“…16 Similar benefits have also been noted during perioperative resuscitation. 18,19 We conducted this study to test the hypothesis that the specific mixture of IV fluids, colloids and different types of crystalloids, used during initial resuscitation, in severe sepsis, is associated with major in-hospital outcomes. We compared in-hospital mortality after the administration of isotonic saline (used exclusively during resuscitation) versus coadministration of balanced crystalloids (such as LR) or colloids.…”