Comparison of the effects of two different formulas of fluids in craniotomy patients


1 Department of Anesthesiology and Critical Care, Alzahra Anesthesiology and Critical Care Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Neuroanesthesiology, Alzahra Anesthesiology and Critical Care Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Anesthesiology, Alzahra Anesthesiology and Critical Care Center, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Intraoperative fluid management of the patients who had undergone neurosurgery presents special challenges for the anesthesiologist. In this study, we aimed to compare the effects of two fluid combinations (half-normal + bicarbonate with saline + Ringer's lactate) on brain relaxation, and acid, base, and hemodynamic balance in patients undergoing elective craniotomy surgery.
Materials and Methods: This randomized double-blind controlled clinical trial study was done on 50 patients, of age 20-60 years, undergoing craniotomy in Alzahra Hospital in 2012. They were divided in two groups of 25 patients each. In the control group, after the patients received hypertonic saline, normal saline serum and Ringer's lactate was administered, and in the half-normal study group, 80 ml of sodium bicarbonate for every liter of it was added. Arterial blood gas (ABG) was taken before the last suture. Brain relaxation before dura opening was registered.
Results: There was no significant difference in heart rate changes (P = 0.054). No significant difference was observed in the mean arterial pressure between the two groups (P = 0.99). Changes in pH, HCO3, and BE were not significantly different (P = 0.99) between the two groups. Urine output in half-normal saline group was significantly higher than in normal saline group. The mean bleeding volume was higher in normal saline group, but was not significantly different (P = 0.54). The mean volume of injected blood was higher in half-normal group with a significant difference (P = 0.54). The injected blood volume mean in half-normal group was higher with no significant difference (P = 0.55). The mean of brain relaxation was not different (P = 0.5).
Conclusion: These two fluids did not show any significant differences in the studied variables in this research.


Renata R, Zornow MH. Fluid management during craniotomy. Cottrell and Young's Neuroanesthesia. Philadelphia, Elsevier Health Science: 2012. p. 147  Back to cited text no. 1
Tommasino C, Moore S, Todd MM. Cerebral effects of isovolemic hemodilution with crystalloid or colloid solutions. Crit Care Med 1988;16:862-8.  Back to cited text no. 2
Levinsky NG. Acidosis and alkalosis. In: Isselbacher KJ, Braunwald E, Wilson JD, editors. Harrison's Principles of Internal Medicine. 13 th ed. New York: McGraw-Hill; 1994. p. 255.  Back to cited text no. 3
Miller LR, Waters JH. Provost, charlton. Miller anesthesiology. Anesthesiology 1994;84:482-3.  Back to cited text no. 4
Fenstermacher JD, Johnson JA. Filtration and reflection coefficients of the rabbit blood -brain barrier. Am J Physiol 1966;211:341-6.  Back to cited text no. 5
Kellum JA. Saline-induced hyperchloremic metabolic acidosis. Crit Care Med 2002;30:259-61.  Back to cited text no. 6
Schakford SR, Fortlage DA, Peters RM, Hollingsworth-Fridlund P, Sise MJ. Serum osmolar and electrolyte changes associated with large infusions of hypertonic sodium lactate for intravascular volume expansion of patients undergoing aortic reconstruction. Surg Gynecol Obstet 1987;164:127-36.  Back to cited text no. 7
Rozet I, Tontisirin N, Muangman S, Vavilala MS, Souter MJ, Lee LA, et al. Effect of equiosmolar solution of mannitol versus hypertonic saline on intraoperative brain relaxation and electrolyte balance. Anethesiology 2007;107:697-704.  Back to cited text no. 8
Sahar A, Tsiptstein E. Effects of mannitol and furosemide on the rate of formatin of cerebrospinale fluid. Exp Neurol 1978;60:584-91.  Back to cited text no. 9
Bunn F, Roberts I, Tasker R, Akpa E. Hypertonic versus isotonic crystalloid for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev 2002;(1):CD002045.  Back to cited text no. 10
Kreimeier U, Bruckner UB, Niemczyk S, Messmer K. Hyperosmotic saline dextran for resuscitation from traumatic-hemorrhagic hypotension: Effect on regional blood flow. Circ Shock 1990;32:83-99.  Back to cited text no. 11
Leppaniemi A, Soltero R, Burris D. Early resuscitations with low-volume polyDClHb is effective in the treatment of shock induced by penetrating vascular injury. J Trauma 1996;40:242.  Back to cited text no. 12
Morgan TJ, Power G, Venkatesh B, Jones MA. Acid-base effects of a bicarbonate-balanced priming fluid during cardiopulmonary bypass: Comparison with Plasma-Lyte 148. A randomised single-blinded study. Anaesth Intensive Care 2008;36:822-9.  Back to cited text no. 13
Adolph E, Holdt-Lehmann B, Chatterjee T, Paschka S, Prott A, Schneider H, et al. Renal Insufficiency Following Radiocontrast Exposure Trial (REINFORCE): A randomized comparison of sodium bicarbonate versus sodium chloride hydration for the prevention of contrast-induced nephropathy. Coron Artery Dis. 2008;19:413-9.  Back to cited text no. 14
Vasheghani-Farahani A, Sadigh G, Kassaian SE, Khatami SM, Fotouhi A, Razavi SA, et al. Sodium bicarbonate plus isotonic saline versus saline for prevention of contrast-induced nephropathy in patients undergoing coronary angiography: A randomized controlled trial. Am J Kidney Dis 2009,54:610-8.  Back to cited text no. 15
Navaneethan SD, Singh S, Appasamy S, Wing RE, Sehgal AR. Sodium bicarbonate therapy for prevention of contrast-induced nephropathy: A systematic review and meta-analysis. Am J Kidney Dis 2009;53:617-27.  Back to cited text no. 16