Ringer’S Lactate Versus Sterofundin ® Iso in Paediatric Surgical Patients: The Acid Base and Electrolytes Assessment
International Journal of Anesthesia and Clinical Medicine
Volume 6, Issue 1, June 2018, Pages: 33-39
Received: Jan. 14, 2018; Accepted: May 14, 2018; Published: Jul. 4, 2018
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Hasyizan Mohamad Hassan, Department of Anesthesia and Intensive Care, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
Nurul Ashikin Hasbullah, Department of Anesthesia and Intensive Care, Hospital Raja Perempuan Zainab 2, Kota Bharu, Malaysia
Saedah Ali, Department of Anesthesia and Intensive Care, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
Ruwaida Isa, Department of Anesthesia and Intensive Care, Hospital Raja Perempuan Zainab 2, Kota Bharu, Malaysia
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The ideal intraoperative intravenous fluid in paediatric anaesthesia and surgery is still debatable. This is essential to overcome physiological changes to maintain safety and wellbeing of the patient. A new isotonic “balanced solution” (Sterofundin ® ISO) has been introduced to replace existing intraoperative fluid of choice (Ringer’s Lactate). The study aimed to observe any changes in electrolytes and acid base after infusion of each study solutions and to evaluate any post infusion electrolytes and acid base differences between both study solutions. The double blinded randomized control trial involved 141 paediatric patients who were subjected to minor surgical procedure of less than 3 hours were randomized into Ringer’s Lactate or Sterofundin ® ISO group. The electrolytes and acid base parameters were assessed at pre-infusion and post-infusion time. There were significant difference in glucose, potassium (K+) and chloride (Cl-) level between pre-infusion and post-infusion values with those given Ringer’s Lactate. There were also significant different in pH, base excess, glucose, Calcium (Ca2+), Chloride (Cl) and lactate level between pre-infusion and post-infusion values with Sterofundin ® ISO. When comparing the mean difference (pre-infusion and post-infusion) between Ringer’s Lactate and Sterofundin ® ISO, calcium (Ca2+) is the only electrtolyte which found to be significant (P=0.015) with the values of (Means±SD 0.005±0.07) mmol/L and (Means±SD 0.02±0.06) mmol/L respectively. Both study solutions showed variable effects of electrolytes and acid base parameters and no fluid was found to be superior in paediatric surgical patients underwent minor surgery of less than three hours.
Sterofundin ® ISO, Ringer’s Lactate, Paediatric, Minor Surgery, Electrolytes, Acid-Base Balance
To cite this article
Hasyizan Mohamad Hassan, Nurul Ashikin Hasbullah, Saedah Ali, Ruwaida Isa, Ringer’S Lactate Versus Sterofundin ® Iso in Paediatric Surgical Patients: The Acid Base and Electrolytes Assessment, International Journal of Anesthesia and Clinical Medicine. Vol. 6, No. 1, 2018, pp. 33-39. doi: 10.11648/j.ja.20180601.16
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Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics. 1957; 19(5):823-32.
Camboulives J. Fluid, transfusion, and blood sparing techniques. B Bissonnette BD Pediatric Anesthesia, principles & practice New York: Mc Graw Hill. 2002:576-99.
Paut O, Lacroix F. Recent developments in the perioperative fluid management for the paediatric patient. Current Opinion in anesthesiology. 2006; 19(3):268-77.
Way C, Dhamrait R, Wade A, Walker I. Perioperative fluid therapy in children: a survey of current prescribing practice. British journal of anaesthesia. 2006; 97 (3):371-9.
Murat I, DUBOIS MC. Perioperative fluid therapy in pediatrics. Pediatric anesthesia. 2008; 18(5):363-70.
Holliday MA, Friedman AL, Segar WE, Chesney R, Finberg L. Acute hospital-induced hyponatremia in children: a physiologic approach. The Journal of pediatrics. 2004; 145 (5):584-7.
Moritz ML, Ayus JC. Prevention of hospital-acquired hyponatremia: a case for using isotonic saline. Pediatrics. 2003; 111 (2):227-30.
Zornow MH, Scheller MS, Shackford SR. Effect of a hypertonic lactated Ringer's solution on intracranial pressure and cerebral water content in a model of traumatic brain injury. Journal of Trauma and Acute Care Surgery. 1989; 29 (4):484-8.
Holcroft JW, Trunkey DD. Extravascular lung water following hemorrhagic shock in the baboon: Comparison between resuscitation with Ringer's lactate and Plasmanate. Annals of surgery. 1974; 180(4):4.
Kamp-Jensen M, Olesen K, Bach V, Schütten H, Engquist A. Changes in serum electrolyte and atrial natriuretic peptide concentrations, acid-base and haemodynamic status after rapid infusion of isotonic saline and Ringer lactate solution in healthy volunteers. British journal of anaesthesia. 1990; 64(5):606-10.
Thomas D, Alberti K. Hyperglycaemic effects of Hartmann's solution during surgery in patients with maturity onset diabetes. British journal of anaesthesia. 1978; 50 (2):185-8.
De Jonghe B, Cheval C, Misset B, Timsit J-F, Garrouste M, Montuclard L, et al. Relationship between blood lactate and early hepatic dysfunction in acute circulatory failure. Journal of critical care. 1999; 14(1):7-11.
Guidet B, Soni N, Della Rocca G, Kozek S, Vallet B, Annane D, et al. A balanced view of balanced solutions. Crit Care. 2010; 14(5):325.
Gan T, Bennett-Guerrero E, Phillips-Bute B, Wakeling H, Moskowitz D, Olufolabi Y, et al. Hextend [registered sign], a Physiologically Balanced Plasma Expander for Large Volume Use in Major Surgery: A Randomized Phase III Clinical Trial. Anesthesia & Analgesia. 1999;88(5):992-8.
Wilkes NJ, Woolf R, Mutch M, Mallett SV, Peachey T, Stephens R, et al. The effects of balanced versus saline-based hetastarch and crystalloid solutions on acid-base and electrolyte status and gastric mucosal perfusion in elderly surgical patients. Anesthesia & Analgesia. 2001; 93 (4):811-6.
Wilkes NJ, Woolf RL, Powanda MC, Gan TJ, Machin SJ, Webb A, et al. Hydroxyethyl starch in balanced electrolyte solution (Hextend®)—Pharmacokinetic and pharmacodynamic profiles in healthy volunteers. Anesthesia & Analgesia. 2002; 94(3):538-44.
Boldt J. Volume therapy in cardiac surgery: are Americans different from Europeans? Journal of cardiothoracic and vascular anesthesia. 2006; 20(1):98-1.
Boldt J. II. The balanced concept of fluid resuscitation. British journal of anaesthesia. 2007; 99 (3):312-5.
Nair SG, Balachandran R. Perioperative fluid and electrolyte management in paediatric patients. Indian J Anaesth. 2004;48(5):355-64.
Hadimioglu N, Saadawy I, Saglam T, Ertug Z, Dinckan A. The effect of different crystalloid solutions on acid-base balance and early kidney function after kidney transplantation. Anesthesia & Analgesia. 2008; 107 (1):264-9.
Lindahl S. Energy expenditure and fluid and electrolyte requirements in anesthetized infants and children. Anesthesiology. 1988; 69 (3):377-82
Mythen MG, Hamilton MA. Hyperchloremic metabolic acidosis: is it clinically relevant? Transfusion alternatives in transfusion medicine. 2001; 3 (4):15-9.
Dorje P, Adhikary G, Tempe DK. Avoiding iatrogenic hyperchloremic acidosis—call for a new crystalloid fluid. The Journal of the American Society of Anesthesiologists. 2000;92(2):625.
Adelman R, Solhaug M. Pathophysiology of body fluids and fluid therapy. Nelson textbook of pediatrics Philadelphia, PA: WB Saunders. 2000:211-22.
Burrows FA, Shutack JG, Crone RK. Inappropriate secretion of antidiuretic hormone in a postsurgical pediatric population. Critical care medicine. 1983; 11 (7):527-31.
Suempelmann R, Witt L, Bruett M, Osterkorn D, Koppert W, Osthaus WA. Changes in acid‐base, electrolyte and hemoglobin concentrations during infusion of hydroxyethyl starch 130/0.42/6: 1 in normal saline or in balanced electrolyte solution in children. Pediatric Anesthesia. 2010; 20 (1):100-4.
Disma N, Mameli L, Pistorio A, Davidson A, Barabino P, Locatelli BG, et al. A novel balanced isotonic sodium solution vs normal saline during major surgery in children up to 36 months: a multicenter RCT. Pediatric Anesthesia. 2014; 24 (9):980-6.
Arai T, Inoue A, Uematsu Y, Sako T, Kimura N. Activities of enzymes in the malate–aspartate shuttle and the isoenzyme pattern of lactate dehydrogenase in plasma and peripheral leukocytes of lactating Holstein cows and riding horses. Research in veterinary science. 2003; 75 (1):15-9.
Matsuda Y, Sakurai T, Iino M, Nakayama K. Comparative study on the effects of acetated Ringer's solution, lactated Ringer's solution, Ringer's solution, and 5% glucose-acetated Ringer's solution on canine hemorrhagic shock. Journal of anesthesia. 1994;8(3):326-33
Wooten EW. Calculation of physiological acid-base parameters in multicompartment systems with application to human blood. Journal of Applied Physiology. 2003; 95 (6):2333-44.
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