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The effect of 0.9% saline versus plasmalyte on coagulation in patients undergoing lumbar spinal surgery; a randomized controlled trial

 Jong Wook Song  ;  Jae-Kwang Shim  ;  Na Young Kim  ;  Jaewon Jang  ;  Young-Lan Kwak 
 International Journal of Surgery, Vol.20 : 128-134, 2015 
Journal Title
 International Journal of Surgery 
Issue Date
Acid-Base Equilibrium/drug effects ; Adult ; Aged ; Blood Coagulation/drug effects* ; Blood Loss, Surgical*/statistics & numerical data ; Blood Transfusion/statistics & numerical data ; Blood Transfusion/utilization ; Electrolytes/pharmacology* ; Electrolytes/therapeutic use ; Female ; Fluid Therapy/adverse effects ; Fluid Therapy/methods* ; Humans ; Lumbar Vertebrae/surgery ; Male ; Middle Aged ; Plasma Substitutes/pharmacology* ; Plasma Substitutes/therapeutic use ; Sodium Chloride/pharmacology* ; Sodium Chloride/therapeutic use ; Spinal Fusion* ; Thrombelastography ; Treatment Outcome
0.9% Saline ; Acid-base balance ; Coagulation ; Plasmalyte
INTRODUCTION: In multi-level lumbar spinal fusion surgery yielding a large amount of blood loss, choice of fluid for volume resuscitation is an important issue since it can influence acid-base status, coagulation, and patients' outcome. This study compared the effect of plasmalyte to 0.9% saline on coagulation assessed by rotation thromboelastometry (ROTEM) and acid-base balance in the aforementioned patients. METHODS: Fifty patients were randomly allocated to receive either 0.9% saline or plasmalyte during operation and until postoperative 12 h. ROTEM was performed at 10 min after anesthetic induction and end of surgery. Arterial blood gas analyses were serially performed from 10 min after anesthetic induction until postoperative 12 h. Fluid balance, blood loss, and transfusion requirement were assessed. RESULTS: ROTEM variables showed sporadic deterioration in both groups after surgery without intergroup differences. Intraoperatively, arterial pH, base excess, and bicarbonate concentrations were lower and serum chloride concentrations were higher in the 0.9% saline group compared with the plasmalyte group. The differences in base excess and bicarbonate concentrations persisted until postoperative 12 h. Fluid balance, blood loss, and transfusion requirement were similar between the groups while urine output was greater in the plasmalyte group compared with the 0.9% saline group (3.2 ± 1.6 ml/kg/h vs. 1.8 ± 1.1 ml/kg/h, p = 0.001). CONCLUSION: In contrast to plasmalyte, fluid therapy with 0.9% saline resulted in transient hyperchloremic acidosis in patients undergoing multi-level lumbar spinal fusion, while coagulation assessed by ROTEM analysis and the amount of blood loss were similar between the groups.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Kim, Na Young(김나영) ORCID logo https://orcid.org/0000-0003-3685-2005
Song, Jong Wook(송종욱) ORCID logo https://orcid.org/0000-0001-7518-2070
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
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