Incidence of Hyperchloremic Metabolic Acidosis in Use of Balanced Salt Crystalloid Group or 0.9% NaCl with Acetar® Group for General Anesthesia in Craniotomy to Remove Tumor

Abstract

Background: Intravenous fluids are used daily for general
anesthesia. Normal saline (0.9% NaCl) is an isotonic
solution. Excessive use of saline has been observed to
result in hyperchloremic acidosis. Newer balanced
solutions having fewer electrolytes composition different
than plasma may avoid this effect. This study compared
change in acid-base balance and serum electrolyte with
use of 0.9% NaCl combined with Acetar® in 1:1 ratio group
and Sterofundin group.
Methods: Twenty-eight adult patients with ASA 1-3 who
were scheduled for craniotomy to remove tumor under
general anesthesia were randomized into two groups.
A balanced salt crystalloid group received sterofundin for
intravenous fluids. A 0.9% NaCl plus Acetar® group
received 0.9% NaCl and Acetar® in 1:1 ratio. Demographic
data and anesthetic data were recorded. The amount of
IV fluid given was guided with the goal directed to keep
euvolemia by an anesthesiologist. Arterial blood gas, base excess, and serum electrolytes were recorded at the
beginning of surgery, postoperative 1 hour, and 1 day. Two
patients were excluded due to incomplete records.
Results: Serum base excess and pH in baseline and
postoperative in Sterofundin group had more alkalosis but
was still in the normal range. A change in serum sodium
and chloride did not yield a statistical difference in both
groups. The amount of blood loss, urine output, operation
time, PRC, and total crystalloid given were not statistically
different. No patient developed acidosis.
Conclusion: Using Sterofundin® for IV fluids was not
different in incidence of hyperchloremic metabolic acidosis,
sodium and chloride than 0.9% NaCl plus Acetar® in 1:1
ratio for craniotomy to remove tumor. Using 0.9% NaCl
plus Acetar® in 1:1 ratio was a good method to avoid
acidosis from excessive intravenous 0.9% NaCl.