CoChat
Sign Up
Cited by 410Hemodynamic Monitoring and TherapyTrauma, Hemostasis, Coagulopathy, ResuscitationBlood transfusion and management

Normal Saline Versus Lactated Ringer’s Solution for Intraoperative Fluid Management in Patients Undergoing Abdominal Aortic Aneurysm Repair: An Outcome Study

Waters, Jonathan H., Gottlieb, Alexandru, Schoenwald, Peter, Popovich, Marc J., Sprung, Juraj, Nelson, David R.·2001·Anesthesia & Analgesia
DOI 10.1097/00000539-200110000-00004
Open this paper in CoChat — free account

Abstract

UNLABELLED: Metabolic acidosis and changes in serum osmolarity are consequences of 0.9% normal saline (NS) solution administration. We sought to determine if these physiologic changes influence patient outcome. Patients undergoing aortic reconstructive surgery were enrolled and were randomly assigned to receive lactated Ringer's (LR) solution (n = 33) or NS (n = 33) in a double-blinded fashion. Anesthetic and fluid management were standardized. Multiple measures of outcome were monitored. The NS patients developed a hyperchloremic acidosis and received more bicarbonate therapy (30 +/- 62 mL in the NS group versus 4 +/- 16 mL in the LR group; mean +/- SD), which was given if the base deficit was greater than -5 mEq/L. The NS patients also received a larger volume of platelet transfusion (478 +/- 302 mL in the NS group versus 223 +/- 24 mL in the LR group; mean +/- SD). When all blood products were summed, the NS group received significantly more blood products (P = 0.02). There were no differences in duration of mechanical ventilation, intensive care unit stay, hospital stay, and incidence of complications. When NS was used as the primary intraoperative solution, significantly more acidosis was seen on completion of surgery. This acidosis resulted in no apparent change in outcome but required larger amounts of bicarbonate to achieve predetermined measurements of base deficit and was associated with the use of larger amounts of blood products. These changes should be considered when choosing fluids for surgical procedures involving extensive blood loss and requiring extensive fluid administration. IMPLICATIONS: Predominant use of 0.9% saline solution in major surgery has little impact on outcome as assessed by duration of mechanical ventilation, intensive care unit stay, hospital stay, and postoperative complications, but it does appear to be associated with increased perioperative blood loss.

Integrity signals

Registry

Crossref · 10.1097/00000539-200110000-00004

Cites

11 of 11 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Normal saline may cause hyperchloremic metabolic acidosis, renal vasoconstriction, increased cytokine secretion, and concern for acute kidney injury.

    “potential adverse effects that include hyperchloremic metabolic acidosis, renal vasoconstriction, increased cytokine secretion and concern about acute kidney injury (AKI) have led to increased interest in chloride-restrictive solutions, known as balanced or buffered solutions [326–330].”

    From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [329]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Waters, J. H., Gottlieb, A., Schoenwald, P., Popovich, M. J., Sprung, J., & Nelson, D. R.
Affiliations
Cleveland Clinic (US)
Corresponding author
Waters, Jonathan H.
ORCID
Venue
Anesthesia & Analgesia
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2001-10
Volume
93
Issue
4
Pages
817-822
ISSN
0003-2999 (ISSN-L)
DOI
10.1097/00000539-200110000-00004
OpenAlex
W2117005662
Cited by
410
References
11
Citations by year
2026: 2 · 2025: 2 · 2024: 4 · 2023: 11 · 2022: 12 · 2021: 14 · 2020: 12 · 2019: 11 · 2018: 28 · 2017: 24 · 2016: 35 · 2015: 25 · 2014: 28 · 2013: 16 · 2012: 21
FWCI
12.20
Type
journal article
Language
en
Open access
closed
Locations
  • Anesthesia & Analgesia (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
  • Health Sciences › Medicine › Biochemistry › Blood transfusion and management
Keywords
normal saline, lactated Ringer's solution, intraoperative fluid management, abdominal aortic aneurysm repair, hyperchloremic metabolic acidosis, bicarbonate therapy, base deficit, serum osmolarity, perioperative blood loss, platelet transfusion, blood product transfusion, postoperative outcomes
MeSH terms
Ringer's Solution, Aged, Blood Gas Analysis, Female, Fluid Therapy, Humans, Intraoperative Period, Isotonic Solutions, Male, Middle Aged, Respiration, Artificial, Sodium Chloride, Vascular Surgical Procedures, Treatment Outcome, Aortic Aneurysm, Abdominal

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review