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Balanced Crystalloids Versus Saline for Perioperative Intravenous Fluid Administration in Children Undergoing Neurosurgery

A Randomized Clinical Trial

Lima, Mariana F., MD*,†; Neville, Iuri S., MD; Cavalheiro, Sergio, MD, PhD§; Bourguignon, Dafne C., MD, PhD; Pelosi, Paolo, MD, FERS; Malbouisson, Luiz M.S., MD, PhD*

Journal of Neurosurgical Anesthesiology: January 2019 - Volume 31 - Issue 1 - p 30–35
doi: 10.1097/ANA.0000000000000515
Clinical Investigations

Background: Balanced crystalloid solutions induce less hyperchloremia than normal saline, but their role as primary fluid replacement for children undergoing surgery is unestablished. We hypothesized that balanced crystalloids induce less chloride and metabolic derangements than 0.9% saline solutions in children undergoing brain tumor resection.

Methods: In total, 53 patients (age range, 6 mo to 12 y) were randomized to receive balanced crystalloid (balanced group) or 0.9% saline solution (saline group) during and after (for 24 h) brain tumor resection. Serum electrolyte and arterial blood gas analyses were performed at the beginning of surgery (baseline), after surgery, and at postoperative day 1. The primary trial outcome was the absolute difference in serum chloride concentrations (post-preopΔCl) measured after surgery and at baseline. Secondary outcomes included the post-preopΔ of other electrolytes and base excess (BE); hyperchloremic acidosis incidence; and the brain relaxation score, a 4-point scale evaluated by the surgeon for assessing brain edema.

Results: Saline infusion increased post-preopΔCl (6 [3.5; 8.5] mmol/L) compared with balanced crystalloid (0 [−1.0; 3.0] mmol/L; P<0.001). Saline use also resulted in increased post-preopΔBE (−4.4 [−5.0; −2.3] vs. −0.4 [−2.7; 1.3] mmol/L; P<0.001) and hyperchloremic acidosis incidence (6/25 [24%] vs. 0; P=0.022) compared with balanced crystalloid. Brain relaxation score was comparable between groups.

Conclusions: In children undergoing brain tumor resection, saline infusion increased variation in serum chloride compared with balanced crystalloid. These findings support the use of balanced crystalloid solutions in children undergoing brain tumor resection.

Departments of *Anesthesiology

Neurosurgery, Hospital das Clínicas, University of São Paulo

Department of Anesthesiology

Pediatric Intensive Care Unit, Instituto de Oncologia Pediátrica

§Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil

Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinico Hospital, IRCCS for Oncology, Genoa, Italy

M.F.L.: had full access to the data in the study and takes responsibility for the integrity of the data and the accuracy of data analysis. I.S.N., S.C., D.C.B., and L.M.S.M.: contributed to the study conception and design, the acquisition, and interpretation of the data, drafting, and a critical review of the article; they also approved the final version for publication. P.P.: contributed to the interpretation of the data, critical review of the article, and approved the final version for publication.

The authors have no funding or conflicts of interest to disclose.

Address correspondence to: Mariana F. Lima, MD, Rua Dr. Eneas Carvalho Aguiar, 255, Room 6040, São Paulo 05403-000, Brazil (e-mail:

Received January 25, 2018

Accepted May 9, 2018

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