Effects of two different strategies of fluid administration on inflammatory mediators, plasma electrolytes and acid/base disorders in patients undergoing major abdominal surgery: a randomized double blind study

Carlo Alberto Volta, Alessandro Trentini, Lucia Farabegoli, Maria Cristina Manfrinato, Valentina Alvisi, Franco Dallocchio, Elisabetta Marangoni, Raffaele Alvisi, Tiziana Bellini, Carlo Alberto Volta, Alessandro Trentini, Lucia Farabegoli, Maria Cristina Manfrinato, Valentina Alvisi, Franco Dallocchio, Elisabetta Marangoni, Raffaele Alvisi, Tiziana Bellini

Abstract

Background: Administration of normal saline might increase circulating levels of pro-inflammatory cytokines and may cause variation of plasmatic electrolytic and hyperchloremic acidosis, which in turn can impair renal function. Hence the use of balanced solutions could influence the inflammatory cascade triggered by the surgical procedures, the plasmatic electrolyte concentration, the acid-base equilibrium, and the renal function.

Methods: This is a double blind randomized trial. Forty patients undergoing major abdominal surgery (bowel cancer) were allocated in two groups, the balanced solution (BS) group in which the fluids administered were balanced solutions (colloids and crystalloids); and the unbalanced solution (UBS) group in which the fluids administered were unbalanced solutions (colloids and crystalloids). Measurements were performed after anaesthesia induction (T0), at the end of surgery (T1), within 2 h after surgery (T2) and 24 h after the beginning of surgery (T3). The following data were collected: 1) active matrix metalloproteinase 9 (MMP-9) and its tissue inhibitor (TIMP-1), IL-6, IL-8, IL-10; 2) blood gases variables; 3) electrolytes, albumin, total serum protein and the strong ion difference; 4) neutrophil gelatinase-associated lipocalin (NGAL) from urinary sample.

Results: The BS group exhibited higher circulating level of IL-10 and TIMP-1 and lower level of active MMP-9. The UBS group experienced hypercloremia, hypocalcemia, hypomagnesemia, worse acid-base equilibrium and higher level of NGAL.

Conclusions: The use of balanced solutions was responsible of less alteration of plasmatic electrolytes, acid-base equilibrium, kidney function and it might be associated with an early anti-inflammatory mechanisms triggering.

Trial registration: ClinicalTrials.gov (Ref: NCT01320891).

Figures

Figure 1
Figure 1
Changes of tissue specific inhibitor of metalloproteinases (TIMP-1) and the ratio between matrix metalloproteinase – 9 (MMP-9) and TIMP-1. POD: postoperative day. Data are presented as mean ± SD. * p < 0.01.
Figure 2
Figure 2
Changes of Chloride, Calcium and Magnesium plasma levels. Note that 38% of the patients of the UBS group received Calcium after surgery. POD: postoperative day. Data are presented as mean ± SD. * p <0.05 and ** p<0.01.
Figure 3
Figure 3
Changes of pH (panel A), Strong Ion Difference (panel B) and neutrophil gelatinase-associated lipocalin (panel C). POD: postoperative day. Data are presented as mean ± SD for pH and SID; as mean ± SE for NGAL. * p <0.05 and ** p<0.01.

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