Acid–base and hemodynamic status of patients with intraoperative hemorrhage using two solution types: Crystalloid Ringer lactate and 1.3% sodium bicarbonate in half-normal saline solution

Authors
Sayed Jalal Hashemi
Sayed Morteza Heidari
Ahmad Yaraghi
Reza Seirafi
Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Intraoperative hemorrhage is one of the problems during surgery and, if it happens in a high volume without an immediate action to control, it can be fatal. Nowadays, various injectable solutions are used. The aim of this study was to compare the acid–base and hemodynamic status of the patient using two solutions, Ringer lactate and 1.3% sodium bicarbonate, in half saline solution.
Materials and Methods: This clinical trial was performed at the Al-Zahra Hospital in 2013 on 66 patients who were randomly selected and put in two studied groups at the onset of hemorrhage. For the first group, crystalloid Ringer lactate solution and for the second group, 1.3% sodium bicarbonate in half-normal saline solution was used. Electrocardiogram, heart rate, O2 saturation non-invasive blood pressure and end-tidal CO2 were monitored. The arterial blood gas, blood electrolytes, glucose and blood urea nitrogen were measured before serum and blood injection. After the infusion of solutions and before blood transfusions, another sample was sent for measurement of blood parameters. Data were analyzed using SPSS software.
Results: The mean arterial pressure was significantly higher in the second group than in the first group at some times after the infusion of solutions. pHh levels, base excess, bicarbonate, sodium, strong ion differences and osmolarity were significantly greater and potassium and chloride were significantly lower in the second group than in the first group after the infusion of solutions.
Conclusion: 1.3% sodium bicarbonate in half-normal saline solution can lead to a proper correction of hemodynamic instability. By maintaining hemodynamic status, osmolarity and electrolytes as well as better balance of acid–base, 1.3% sodium bicarbonate solution in half-normal saline solution can be more effective than Ringer lactate solution during intraoperative bleeding.

Keywords

1.
Irita K. Risk and crisis management in intraoperative hemorrhage: Human factors in hemorrhagic critical events. Korean J Anesthesiol 2011;60:151-60.  Back to cited text no. 1
    
2.
Irita K, Yoshimura H, Sakaguchi Y, Takamatsu C, Tokuda K. Risk and crisis management by anesthesiologists regarding 'Guidelines for Actions Against Intraoperative Critical Hemorrhage' published by the Japanese Society of Anesthesiologists and the Japan Society of Transfusion Medicine and Cell Therapy. Masui 2008;57:1109-16.  Back to cited text no. 2
    
3.
Mikhail J. The trauma triad of death: Hypothermia, acidosis, and coagulopathy. AACN Clin Issues 1999;10:85-94.  Back to cited text no. 3
    
4.
Moore FA, McKinley BA, Moore EE, Nathens AB, West M, Shapiro MB, et al. Inflammation and the Host Response to Injury, a large-scale collaborative project: Patient-oriented research core-standard operating procedures for clinical care. III. Guidelines for shock resuscitation. J Trauma 2006;61:82-9.  Back to cited text no. 4
    
5.
Morgan TJ. The meaning of acid-base abnormalities in the intensive care unit: Part III-effects of fluid administration. Crit Care 2005;9:204-11.  Back to cited text no. 5
    
6.
Ho AM, Karmakar MK, Contardi LH, Ng SS, Hewson JR. Excessive use of normal saline in managing traumatized patients in shock: A preventable contributor to acidosis. J Trauma 2001;51:173-7.  Back to cited text no. 6
    
7.
Reid F, Lobo DN, Williams RN, Rowlands BJ, Allison SP. (Ab) normal saline and physiological Hartmann's solution: A randomized doubleblind crossover study. Clin Sci (Lond) 2003;104:17-24.  Back to cited text no. 7
    
8.
Eingraber S, Rehm M, Sehmisch C, Finsterer U. Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. Anesthesiology 1999;90:1265-70.  Back to cited text no. 8
    
9.
Kaye AD, Riopelle JM. Intravascular Fluid and Electrolyte Physiology. In: Miller RD editor. Miller's Anesthesia. 7th ed. Philadelphia: Churchill Livingstone Elsevier; 2009. p. 1705-37.  Back to cited text no. 9
    
10.
Kaye AD, Riopelle JM. Intravascular Fluid and Electrolyte Physiology. In: Miller RD, editor. Miller's Anesthesia. 7th ed. Philadelphia: Churchill Livingstone Elsevier; 2009. p. 1705-35.  Back to cited text no. 10
    
11.
Ricci Z, Ronco C. Renal Replacement Therapies. In: Miller RD, editors. Miller's Anesthesia. 7th ed. Philadelphia: Churchill Livingstone Elsevier; 2009. p. 2783-803.  Back to cited text no. 11
    
12.
Ganter MT, Hofer CK, Pittet JF. Postoperative Intravascular Fluid Therapy. In: Miller RD, editor. Miller's Anesthesia. 7th ed. Philadelphia: Churchill Livingstone Elsevier; 2009. p. 2957-69.  Back to cited text no. 12
    
13.
Drummond JC, Patel PM. Neurosurgical Anesthesia. In: Miller RD, editor. Miller's Anesthesia. 7th ed. Philadelphia: Churchill Livingstone Elsevier; 2009. p. 2059-60.  Back to cited text no. 13
    
14.
Ayuste EC, Chen H, Koustova E, Rhee P, Ahuja N, Chen Z, et al. Hepatic and pulmonary apoptosis after hemorrhagic shock in swine can be reduced through modifications of conventional Ringer's solution. J Trauma 2006;60:52-63.  Back to cited text no. 14
    
15.
Coskun A, Sen I, Guzelbektes H, Ok M, Turgut K, Canikli S. Comparison of the effects of intravenous administration of isotonic and hypertonic sodium bicarbonate solutions on venous acid-base status in dehydrated calves with strong ion acidosis. J Am Vet Med Assoc 2010;236:1098-103.  Back to cited text no. 15
    
16.
Iwabuchi S, Suzuki K, Abe I, Asano R. Comparison of the effects of isotonic and hypertonic sodium bicarbonate solutions on acidemic calves experimentally induced by ammonium chloride administration. J Vet Med Sci 2003;65:1369-71.  Back to cited text no. 16
    
17.
Joannidis M, Schmid M, Wiedermann CJ. Prevention of contrast media-induced nephropathy by isotonic sodium bicarbonate: A meta-analysis. Wein Klin Wochenschr 2008;120:742-8.  Back to cited text no. 17
    
18.
Neligan PJ, Deutschman CS. Perioperative Acid-Base Balance. In: Miller RD, editor. Miller's Anesthesia. 7th ed. Philadelphia: Churchill Livingstone Elsevier; 2009. p. 1570-1.  Back to cited text no. 18
    
19.
Ghafari MH, Moosavizadeh SA, Moharari RS, Khashayar P. Hypertonic saline 5% vs. lactated ringer for resuscitating patients in hemorrhagic shock: Middle East J Anesthesiol 2008;19:1337-47.  Back to cited text no. 19
    
20.
Noritomi DT, Pereira AJ, Bugano DD, Rehder PS, Silva E. Impact of Plasma-Lyte pH 7.4 on acid-base status and hemodynamics in a model of controlled hemorrhagic shock: Clinics (Sao Paulo) 2011;66:1969-74.  Back to cited text no. 20
    
21.
Scheingraber S, Rehm M, Sehmisch C, Finsterer U. Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. Anesthesiology 1999;90:1265-70.  Back to cited text no. 21
    
22.
Neligan PJ, Deutschman CS. Perioperative Acid-Base Balance. In: Miller RD, editor. Miller's Anesthesia. 7th ed. Philadelphia: Churchill Livingstone Elsevier; 2009. p. 1559-60.  Back to cited text no. 22
    
23.
Fukuta Y, Kumamoto T, Matsuda A, Kataoka M, Kokuba Y. Effects of various Ringer's solutions on acid-base balance in rats in hemorrhagic shock and with hepatic dysfunction. Masui 1998;47:22-8.  Back to cited text no. 23
    
24.
Kees MG, Schlotterbeck H, Passemard R, Pottecher T, Diemunsch P. Ringer solution: Osmolarity and composition revisited. Ann Fr Anesth Reanim 2005;24:653-5.  Back to cited text no. 24
Advanced Biomedical Research
Volume 2016, November
November 2016
Pages 1-7