Balanced Crystalloids Versus Saline for Perioperative Intravenous Fluid Administration in Children Undergoing Neurosurgery: A Randomized Clinical Trial
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Citações na Scopus
26
Tipo de produção
article
Data de publicação
2019
Editora
LIPPINCOTT WILLIAMS & WILKINS
Indexadores
Título da Revista
ISSN da Revista
Título do Volume
Autores
CAVALHEIRO, Sergio
BOURGUIGNON, Dafne C.
PELOSI, Paolo
Autor de Grupo de pesquisa
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Citação
JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY, v.31, n.1, p.30-35, 2019
Resumo
Background: Balanced crystalloid solutions induce less hyperchloremia than normal saline, but their role as primary fluid replacement for children undergoing surgery is unestablished. We hypothesized that balanced crystalloids induce less chloride and metabolic derangements than 0.9% saline solutions in children undergoing brain tumor resection. Methods: In total, 53 patients (age range, 6mo to 12 y) were randomized to receive balanced crystalloid (balanced group) or 0.9% saline solution (saline group) during and after (for 24 h) brain tumor resection. Serum electrolyte and arterial blood gas analyses were performed at the beginning of surgery (baseline), after surgery, and at postoperative day 1. The primary trial outcome was the absolute difference in serum chloride concentrations ((post-preop)Delta Cl-) measured after surgery and at baseline. Secondary outcomes included the (post-preop)Delta of other electrolytes and base excess (BE); hyperchloremic acidosis incidence; and the brain relaxation score, a 4-point scale evaluated by the surgeon for assessing brain edema. Results: Saline infusion increased (post-preop)Delta Cl (6 [3.5; 8.5] mmol/ L) compared with balanced crystalloid (0 [-1.0; 3.0] mmol/ L; P< 0.001). Saline use also resulted in increased (post-preop)Delta BE (-4.4 [-5.0; -2.3] vs. -0.4 [-2.7; 1.3] mmol/L; P<0.001) and hyperchloremic acidosis incidence (6/25 [24%] vs. 0; P= 0.022) compared with balanced crystalloid. Brain relaxation score was comparable between groups. Conclusions: In children undergoing brain tumor resection, saline infusion increased variation in serum chloride compared with balanced crystalloid. These findings support the use of balanced crystalloid solutions in children undergoing brain tumor resection.
Palavras-chave
brain tumor, crystalloid solutions, sodium chloride, hyperchloremic acidosis
Referências
- Allen CH, 2016, BMC PEDIATR, V16, DOI 10.1186/s12887-016-0652-4
- Ayus JC, 2008, AM J PHYSIOL-RENAL, V295, pF619, DOI 10.1152/ajprenal.00502.2007
- Bampoe S, 2017, COCHRANE DB SYST REV, V9
- Burtis CA, 2013, TIETZ TXB CLIN CHEM
- Cecconi M, 2015, INTENS CARE MED, V41, P1529, DOI 10.1007/s00134-015-3850-x
- Chowdhury AH, 2012, ANN SURG, V256, P18, DOI 10.1097/SLA.0b013e318256be72
- Chui J, 2014, CAN J ANESTH, V61, P347, DOI 10.1007/s12630-014-0118-9
- Masevicius FD, 2017, CRIT CARE MED, V45, pe1233, DOI 10.1097/CCM.0000000000002730
- Disma N, 2014, PEDIATR ANESTH, V24, P980, DOI 10.1111/pan.12439
- Dubin A, 2007, CRIT CARE MED, V35, P1264, DOI 10.1097/01.CCM.0000259536.11943.90
- Gelb AW, 2008, ANESTH ANALG, V106, P585, DOI 10.1213/01.ane.0000295804.41688.8a
- Madden JR, 2010, J PEDIATR ONCOL NURS, V27, P21, DOI 10.1177/1043454209340320
- Mahler SA, 2011, AM J EMERG MED, V29, P670, DOI 10.1016/j.ajem.2010.02.004
- Mann C, 2009, PEDIATR ANESTH, V19, P1070, DOI 10.1111/j.1460-9592.2009.03126.x
- McCluskey SA, 2013, ANESTH ANALG, V117, P412, DOI 10.1213/ANE.0b013e318293d81e
- Mcnab S, 2014, COCHRANE DB SYST REV, DOI 10.1002/14651858.CD009457.pub2
- Mcnab S, 2015, LANCET, V385, P1190, DOI 10.1016/S0140-6736(14)61459-8
- Rasmussen M, 2004, J NEUROSURG, V101, P621, DOI 10.3171/jns.2004.101.4.0621
- Roquilly A, 2013, CRIT CARE, V17, P77
- Selewski DT, 2014, INTENS CARE MED, V40, P1481, DOI 10.1007/s00134-014-3391-8
- Self WH, 2018, NEW ENGL J MED, V378, P819, DOI 10.1056/NEJMoa1711586
- Semler MW, 2018, NEW ENGL J MED, V378, P829, DOI 10.1056/NEJMoa1711584
- Semler MW, 2017, AM J RESP CRIT CARE, V195, P1362, DOI 10.1164/rccm.201607-1345OC
- Sen Ayan, 2017, Crit Care Med, V45, pe146, DOI 10.1097/CCM.0000000000002063
- Serpa Neto Ary, 2017, Ann Transl Med, V5, P323, DOI 10.21037/atm.2017.07.38
- Shaw AD, 2012, ANN SURG, V255, P821, DOI 10.1097/SLA.0b013e31825074f5
- Stenson EK, 2018, PEDIATR CRIT CARE ME, V19, P155, DOI 10.1097/PCC.0000000000001401
- Story DA, 2007, ANESTH ANALG, V104, P893, DOI 10.1213/01.ane.0000258015.87381.61
- Sumpelmann R, 2017, PEDIATR ANESTH, V27, P10, DOI 10.1111/pan.13007
- Sumpelmann R, 2010, PEDIATR ANESTH, V20, P977, DOI 10.1111/j.1460-9592.2010.03428.x
- Thongprayoon C, 2017, PLOS ONE, V12, DOI 10.1371/journal.pone.0174430
- TOMMASINO C, 1988, CRIT CARE MED, V16, P862, DOI 10.1097/00003246-198809000-00009
- van der Jagt M, 2016, CRIT CARE, V20, DOI 10.1186/s13054-016-1309-2
- WILCOX CS, 1983, J CLIN INVEST, V71, P726, DOI 10.1172/JCI110820
- Young JB, 2014, ANN SURG, V259, P255, DOI 10.1097/SLA.0b013e318295feba
- Young P, 2015, JAMA-J AM MED ASSOC, V314, P1701, DOI 10.1001/jama.2015.12334