Glucose anhydrous 20g / Sodium chloride 3.5g / Sodium citrate 2.9g oral powder sachets

IntroductionIntravenous crystalloid fluid infusion is a mandatory nutritional intervention received by surgical patients. Crystalloids vary in the pH value and electrolyte balance when administered; these effects directly alter plasma and urine compositions and can considerably affect the patient's intraoperative metabolism.MethodsThis randomized controlled study compared 0.9% saline solution and lactated Ringer's solution in terms of intraoperative metabolism among 56 patients undergoing lumbar spinal surgery. Blood and urine samples were obtained before and after surgery for arterial blood gas analysis and untargeted metabolomic analysis using liquid chromatography-mass spectrometry.ResultsPatients receiving 0.9% saline developed hyperchloremic acidosis and exhibited higher postoperative plasma concentrations of sodium (interaction P = 0.008) and glucose (interaction P = 0.034). They also required higher intraoperative norepinephrine doses (18 [0-43] μg vs. 0 [0-5] μg; P P = .051); significantly higher oxaloacetate concentrations (interaction P = .015), which may indicate less intraoperative gluconeogenesis (interaction P = .015); lower leucine degradation metabolite concentration, namely hydroxyisocaproic acid (interaction P = .055); and an attenuated decline in anti-inflammatory phospholipid breakdown metabolite, namely 15-ketoeicosatetraenoic acid (interaction P = .063). By contrast, patients receiving 0.9% saline solution exhibited unfavorable metabolism in urine indicated by reduced excretion of citric acid and creatine, which correlated with reduced glomerular filtration rates.ConclusionsThe administration of lactated Ringer's solution may facilitate more favorable intraoperative metabolic profiles than the administration of 0.9% saline solution during lumbar spinal surgery.

Abstract licence: CC BY-NC