Normal saline versus lactated Ringer's solution for intraoperative fluid management in patients undergoing abdominal aortic aneurysm repair: An outcome study

Metabolic acidosis and changes in serum osmolarity are consequences of 0.9% normal saline (NS) solution administration. We sought to determine if thes e physiologic changes influence patient outcome. Patients undergoing aortic reconstructive surgery were enrolled and were randomly assigned to receive lactated Ringer's (LR) solution (n = 33) or NS (n = 33) in a double-blinde d fashion. Anesthetic and fluid management were standardized. Multiple meas ures of outcome were monitored. The NS patients developed a hyperchloremic acidosis and received more bicarbonate therapy (30 +/- 62 mL in the NS grou p versus 4 +/- 16 mL in the LR group; mean +/- SD), which was given if the base deficit was greater than -5 mEq/L. The NS patients also received a lar ger volume of platelet transfusion (478 +/- 302 mL in the NS group versus 2 23 +/- 24 mL in the LR group; mean +/- SD). When all blood products were su mmed, the NS cup received significantly more blood products (P = 0.02). The re were no differences in duration of mechanical ventilation, intensive car e unit stay, hospital stay, and incidence of complications. When NS was use d as the primary intraoperative solution, significantly more acidosis was s een on completion of surgery. This acidosis resulted in no apparent change in outcome but required larger amounts of bicarbonate to achieve predetermi ned measurements of base deficit and was associated with the use of larger amounts of blood products. These changes should be considered when choosing fluids for surgical procedures involving extensive blood loss and requirin g extensive fluid administration.