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Title: The effects of plasmalyte-148 versus hartmann's solution during major liver resection: a multicentre, double-blind, randomized controlled trial.
Austin Authors: Weinberg, Laurence ;Pearce, B ;Sullivan, R;Siu, L;Scurrah, N ;Tan, C ;Backtrom, M;Nikfarjam, Mehrdad ;McNicol, Larry;Story, David A ;Christophi, Christopher ;Bellomo, Rinaldo 
Affiliation: Consultant anesthetist, Department of Anesthesia, Austin Hospital, Principal Fellow, Department of Surgery, and Perioperative and Pain Medicine Unit, Melbourne Medical School, The University Melbourne, Melbourne, Victoria, Australia
Issue Date: 2015 2014-11-19
Publication information: Minerva Anestesiologica 2015; 81(12): 1288-97
Abstract: The acid--base, biochemical and hematological effects of crystalloid solutions have not been comprehensively evaluated in patients with liver resection.Design: Multicenter, prospective, double--blind randomized controlled trial investigating the biochemical effects of Hartmann's solution (HS) or Plasmalyte--148 (PL) in 60 patients undergoing major liver resection. Primary outcome: Base Excess immediately after surgery. Secondary outcomes: changes in blood biochemistry and hematology.At completion of surgery, patients receiving HS had equivalent mean standard Base Excess (--1.7 ± 2.2 vs. --0.9 ± 2.3 meq/L; p=0.17) to those treated with PL. However, patients treated with HS were more hyperchloremic (difference 1.7 mmol/L, 95% CI: 0.2 to 3.2, p=0.03) and hyperlactatemic (difference 0.8 mmol/L, 95% CI: 0.2 to 1.3; p=0.01). In contrast, patients receiving PL had higher mean plasma magnesium levels and lower ionized calcium levels. There were no significant differences in pH, bicarbonate, albumin and phosphate levels. Immediately after surgery, mean PT and aPTT were significantly lower in the PL group. Intraoperatively, the median (IQR) blood loss in the PL group was 300 ml (200:413) vs. 500 ml (300:638) in the HS group (p=0.03). Correspondingly, the postoperative hemoglobin was higher in the PL group. Total complications were more frequent in the HS Group (56% vs. 20%, relative risk 2.8; 95% CI: 1.3 to 6.1; p=0.007).In liver resection patients, HS and PL led to similar Base Excess values but different post operative plasma biochemistry and hematology values. Understanding of these effects may help clinicians individualize fluid therapy in these patients.
ORCID: 0000-0001-7403-7680
Journal: Minerva anestesiologica
PubMed URL: 25407026
Type: Journal Article
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