The Effects of Balanced Versus Saline-Based Hetastarch and Crystalloid Solutions on Acid-Base and Electrolyte Status and Gastric Mucosal Perfusion in Elderly Surgical Patients

• Published in: Anesthesia and analgesia Vol. 93; no. 4; pp. 811 - 816
• Main Authors: Wilkes, Nicholas J., Woolf, Rex, Mutch, Marjorie, Mallett, Susan V., Peachey, Tim, Stephens, Robert, Mythen, Michael G.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01-10-2001; Lippincott
• Subjects: Acid-Base Equilibrium - drug effects; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Double-Blind Method; Female; Gastric Mucosa - drug effects; Gastric Mucosa - metabolism; Humans; Hydroxyethyl Starch Derivatives - administration & dosage; Hydroxyethyl Starch Derivatives - chemistry; Male; Medical sciences; Postoperative Period; Prospective Studies; Regional Blood Flow - drug effects; Splanchnic Circulation - drug effects; Splanchnic Circulation - physiology; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Water-Electrolyte Balance - drug effects; Human; Intravenous administration; Electrolyte solution; Splanchnic region; Glucose; Sodium chloride; Colloid; Plasma substitute; Acid base balance; Crystalloid solution; Perfusion; Surgery; Hemodynamics; Starch(hydroxyethyl); Elderly; Comparative study
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1097/00000539-200110000-00003

The IV administration of sodium chloride solutions may produce a metabolic acidosis and gastrointestinal dysfunction. We designed this trial to determine whether, in elderly surgical patients, crystalloid and colloid solutions with a more physiologically balanced electrolyte formulation, such as Hartmann’s solution and Hextend®, can provide a superior metabolic environment and improved indices of organ perfusion when compared with saline-based fluids. Forty-seven elderly patients undergoing major surgery were randomly allocated to one of two study groups. Patients in the Balanced Fluid group received an intraoperative fluid regimen that consisted of Hartmann’s solution and 6% hetastarch in balanced electrolyte and glucose injection (Hextend). Patients in the Saline group were given 0.9% sodium chloride solution and 6% hetastarch in 0.9% sodium chloride solution (Hespan®). Biochemical indices and acid-base balance were determined. Gastric tonometry was used as a reflection of splanchnic perfusion. Postoperative chloride levels demonstrated a larger increase in the Saline group than the Balanced Fluid group (9.8 vs 3.3 mmol/L, P = 0.0001). Postoperative standard base excess showed a larger decline in the Saline group than the Balanced Fluid group (−5.5 vs −0.9 mmol/L, P = 0.0001). Two-thirds of patients in the Saline group, but none in the Balanced Fluid group, developed postoperative hyperchloremic metabolic acidosis (P = 0.0001). Gastric tonometry indicated a larger increase in the CO2 gap during surgery in the Saline group compared with the Balanced Fluid group (1.7 vs 0.9 kPa, P = 0.0394). In this study, the use of balanced crystalloid and colloid solutions in elderly surgical patients prevented the development of hyperchloremic metabolic acidosis and resulted in improved gastric mucosal perfusion when compared with saline-based solutions.