The effects of plasmalyte-148 vs. Hartmann's solution during major liver resection

A multicentre, double-blind, randomized controlled trial

L. Weinberg, B. Pearce, R. Sullivan, L. Siu, N. Scurrah, C. Tan, M. Backstrom, M. Nikfarjam, L. Mcnicol, D. Story, C. Christophi, R. Bellomo

Research output: Contribution to journalArticleResearchpeer-review

10 Citations (Scopus)

Abstract

Background. The acid-base, biochemical and hematological effects of crystalloid solutions have not been comprehensively evaluated in patients with liver resection. Methods. 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. Results. 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). Conclusion. 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.

Original languageEnglish
Pages (from-to)1288-1297
Number of pages10
JournalMinerva Anestesiologica
Volume81
Issue number12
Publication statusPublished - Dec 2015
Externally publishedYes

Keywords

  • Acid base equilibrium
  • Hartmann's solution
  • Hepatectomy
  • Plasmalyte-148

Cite this

Weinberg, L. ; Pearce, B. ; Sullivan, R. ; Siu, L. ; Scurrah, N. ; Tan, C. ; Backstrom, M. ; Nikfarjam, M. ; Mcnicol, L. ; Story, D. ; Christophi, C. ; Bellomo, R. / The effects of plasmalyte-148 vs. Hartmann's solution during major liver resection : A multicentre, double-blind, randomized controlled trial. In: Minerva Anestesiologica. 2015 ; Vol. 81, No. 12. pp. 1288-1297.
@article{172e530304344ed6b93258d03c1dca05,
title = "The effects of plasmalyte-148 vs. Hartmann's solution during major liver resection: A multicentre, double-blind, randomized controlled trial",
abstract = "Background. The acid-base, biochemical and hematological effects of crystalloid solutions have not been comprehensively evaluated in patients with liver resection. Methods. 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. Results. 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). Conclusion. 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.",
keywords = "Acid base equilibrium, Hartmann's solution, Hepatectomy, Plasmalyte-148",
author = "L. Weinberg and B. Pearce and R. Sullivan and L. Siu and N. Scurrah and C. Tan and M. Backstrom and M. Nikfarjam and L. Mcnicol and D. Story and C. Christophi and R. Bellomo",
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Weinberg, L, Pearce, B, Sullivan, R, Siu, L, Scurrah, N, Tan, C, Backstrom, M, Nikfarjam, M, Mcnicol, L, Story, D, Christophi, C & Bellomo, R 2015, 'The effects of plasmalyte-148 vs. Hartmann's solution during major liver resection: A multicentre, double-blind, randomized controlled trial', Minerva Anestesiologica, vol. 81, no. 12, pp. 1288-1297.

The effects of plasmalyte-148 vs. Hartmann's solution during major liver resection : A multicentre, double-blind, randomized controlled trial. / Weinberg, L.; Pearce, B.; Sullivan, R.; Siu, L.; Scurrah, N.; Tan, C.; Backstrom, M.; Nikfarjam, M.; Mcnicol, L.; Story, D.; Christophi, C.; Bellomo, R.

In: Minerva Anestesiologica, Vol. 81, No. 12, 12.2015, p. 1288-1297.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - The effects of plasmalyte-148 vs. Hartmann's solution during major liver resection

T2 - A multicentre, double-blind, randomized controlled trial

AU - Weinberg, L.

AU - Pearce, B.

AU - Sullivan, R.

AU - Siu, L.

AU - Scurrah, N.

AU - Tan, C.

AU - Backstrom, M.

AU - Nikfarjam, M.

AU - Mcnicol, L.

AU - Story, D.

AU - Christophi, C.

AU - Bellomo, R.

PY - 2015/12

Y1 - 2015/12

N2 - Background. The acid-base, biochemical and hematological effects of crystalloid solutions have not been comprehensively evaluated in patients with liver resection. Methods. 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. Results. 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). Conclusion. 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.

AB - Background. The acid-base, biochemical and hematological effects of crystalloid solutions have not been comprehensively evaluated in patients with liver resection. Methods. 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. Results. 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). Conclusion. 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.

KW - Acid base equilibrium

KW - Hartmann's solution

KW - Hepatectomy

KW - Plasmalyte-148

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M3 - Article

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JO - Minerva Anestesiologica

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ER -